Application of Machine Learning in Predicting Perioperative Neurocognitive Disorders in Elderly Patients: The Impact of Sarcopenia-Related Features

Zhengyu Qian¹Xiaochu Wu²He Kunyang¹Kaijie Lin¹Xiaobei Luo³Tianyao Zhang^4*

• ¹Chengdu Medical College, Chengdu, Sichuan, China
• ²West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
• ³Soochow University Medical College, Suzhou, Jiangsu Province, China
• ⁴First Affiliated Hospital of Chengdu Medical College, Chengdu, China

Abstract: Background: Older surgical patients present with diverse clinical profiles, yet research indicates a significant correlation between sarcopenia-related features and the incidence of perioperative neurocognitive disorder (PND). The integration of machine learning techniques offers a promising avenue for identifying older surgical patients at elevated risk of PND, particularly those exhibiting sarcopenia-associated characteristics. This approach enhances preoperative risk stratification and patient selection, thereby improving the precision of clinical management and treatment decisions. Methods: Data were collected from patients undergoing non-cardiac surgery at the First Affiliated Hospital of Chengdu Medical College to develop and validate a predictive model. Five machine learning models—Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), Gradient Boosting Machine (GBM), Adaptive Boosting (AdaBoost), and Random Forest—were constructed to evaluate the risk of PND in older surgical patients. Sarcopenia-related features were incorporated as key variables in these models. The SHapley Additive exPlanations (SHAP) method was subsequently utilized to interpret the most effective model. Results: A total of 443 patients were included in the study. Among the five models, AdaBoost performed best, achieving an AUC of 0.95. The six most important features identified by SHAP were 6-meter walking speed, preoperative MMSE score, maximum grip strength, appendicular skeletal muscle mass, and sarcopenia assessment age. These results demonstrate AdaBoost's excellent predictive performance, with high interpretability and reliability. Conclusion: Machine learning models, particularly AdaBoost integrated with SHAP, show significant potential in predicting PND in older surgical patients. The model's ability to clarify the impact of sarcopenia-related features enhances its clinical utility in preoperative risk assessment.