Generalisable prediction model of surgical case duration: multicentre development and temporal validation

Abstract

Background: Accurate prediction of surgical case duration underpins operating room (OR) scheduling, yet existing models often depend on site- or surgeon-specific inputs and rarely undergo external validation, limiting generalisability. Methods: We undertook a retrospective multicentre study using routinely collected perioperative data from two general hospitals in Japan (development: 1 January 2021-31 December 2023; temporal test: 1 January-31 December 2024). Elective weekday procedures with American Society of Anesthesiologists (ASA) Physical Status 1-4 were included. Pre-specified preoperative predictors comprised surgical context (year, month, weekday, scheduled duration, general anaesthesia indicator, body position) and patient factors (sex, age, body mass index, allergy, infection, comorbidity, ASA). Missing data were addressed by multiple imputation by chained equations. Four learners (elastic-net, generalised additive models, random forest, gradient-boosted trees) were tuned within internal-external cross-validation (IECV; leave-one-cluster-out by centre-year) and combined by stacked generalisation to predict log-transformed duration. Results: We analysed 63,206 procedures (development 45,647; temporal test 17,559). Cluster-specific and pooled errors and calibrations from IECV are provided with consistent performance across centres and years. In the 2024 temporal test cohort, calibration was good (intercept 0.423, 95%CI 0.372 to 0.474; slope 0.921, 95%CI 0.911 to 0.932). Conclusions: A stacked machine-learning model using only widely available preoperative variables achieved accurate, well-calibrated predictions in temporal external validation, supporting transportability across sites and over time. Such general-purpose tools may improve OR scheduling without relying on idiosyncratic inputs.