Validation of Artificial Intelligence-Based POTTER Calculator in Emergency General Surgery Patients Undergoing Laparotomy: Prospective, Bi-Institutional Study

BACKGROUND: The Predictive Optimal Trees in Emergency Surgery Risk (POTTER) calculator, a widely used interpretable artificial intelligence risk calculator, has been validated in population-based studies and shown to predict outcomes in patients who underwent emergency general surgery better than surgeons. We sought to prospectively validate POTTER. STUDY DESIGN: Patients undergoing an emergency exploratory laparotomy for nontrauma indications at 2 academic medical centers between June 2020 and March 2022 were included. POTTER preoperative risk calculations and postoperative outcomes were systematically recorded. POTTER's performance in predicting 30-day postoperative mortality, septic shock, respiratory failure, bleeding, and pneumonia was assessed using the c-statistic methodology. RESULTS: A total of 361 patients were included. The median age was 63 years (interquartile range 51 to 72 years), 45.4% were women, and the overall mortality and morbidity were 24.1% and 51.4%, respectively. POTTER predicted mortality accurately with a c-statistic of 0.90. POTTER also accurately predicted the occurrence of individual postoperative complications, with c-statistics ranging between 0.80 and 0.89. CONCLUSIONS: This is the first prospective validation of the artificial intelligence-enabled POTTER calculator. The superior accuracy, user-friendliness, and interpretability of POTTER make it a useful bedside tool for preoperative patient and family counseling.