Predicting postoperative delayed awakening after flexible ureteroscopic lithotripsy based on radiomic features of body composition

We aimed to explore the predictive role of radiomic features of body compositions in the occurrence of delayed awakening after flexible ureteroscopic lithotripsy, and further develop a predictive model to identify patients at higher risk. We analyzed the data from 314 admitted patients undergoing total intravenous general anesthesia at two institutions. Binary logistic regression was used to assess univariable and multivariable associations of clinical factors with delayed awakening. Radiomic features of body compositions were deeply extracted from preoperative computed tomography (CT) scans using ResNet50 model. We developed a combined model by integrating significant clinical variables with radiomic score. SHapley Additive explanation (SHAP) method was adopted for model interpretation and helping clinicians understand the predictive results. At multivariable analysis, CT-derived visceral adipose tissue area and skeletal muscle index were independent predictors of postoperative delayed awakening. The combined model had area under curves (AUCs) of 0.85(95%CI: 0.82, 0.89), 0.83(95%CI: 0.80, 0.87) and 0.80(95%CI: 0.76, 0.84) in the derivation, internal and external test datasets, respectively. 8 radiomic features were selected using Spearman rank correlation test and the least absolute shrinkage and selection operator logistic regression analysis. This combined model showed better discrimination and calibration than clinical model alone. Furthermore, SHAP plots quantified the impact of key variables on prediction at the global level. The combined model may allow estimation of the risk of postoperative delayed awakening after flexible ureteroscopic lithotripsy.