{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:19:08Z","timestamp":1793643548744,"version":"4.5.1"},"reference-count":86,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surg Innov"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. Traditional risk scores, such as the Society of Thoracic Surgery (STS) and EuroSCORE II, have limitations in predicting outcomes, particularly in high-risk patients. Machine learning (ML) models may address these issues by detecting nuanced data patterns not captured by conventional methods. This systematic review and meta-analysis compared the efficacy of ML models with traditional risk scores in predicting outcomes after CABG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A comprehensive literature search of records up to August 14\n                      <jats:sup>th<\/jats:sup>\n                      2025, was conducted using PubMed, Embase, Web of Science, and the Cochrane Library. Studies included used ML algorithms and traditional risk scores to predict all-cause mortality (in-hospital, 30-day, or longer term as reported by each study) following CABG. Data extraction and quality assessment were independently performed by two reviewers. Meta-analyses were conducted using a linear mixed-effects model, with C-statistics as the primary measure of discrimination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-six studies, comprising 565\u00a0063 participants, met the inclusion criteria. The pooled C-statistic for ML models was 0.82 (95% CI 0.79-0.85), significantly higher than the 0.73 (95% CI 0.71-0.76) for traditional risk scores (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). The top-performing ML model achieved a C-statistic of 0.98 (CI 0.95-1.00). Calibration was reported inconsistently across studies and was synthesised narratively rather than quantitatively. Where reported, ML calibration was generally adequate but a robust head-to-head comparison with traditional risk scores was not possible. Subgroup analyses revealed consistent superior performance of ML models across various algorithms and covariate sets.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In this meta-analysis of predominantly internally-validated models, ML approaches showed higher pooled discrimination than traditional risk scores for mortality after CABG. However, given the small number of pooled studies, very high between-study heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      = 98%), the predominance of high risk-of-bias studies, and the scarcity of external validation, these findings should be interpreted as supporting the promise of ML rather than establishing proof of clinical superiority. Confirmatory prospective, externally validated studies are required before ML can be recommended for routine pre-operative risk stratification.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15533506261468192","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:34:53Z","timestamp":1785990893000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Machine-Learning Versus Traditional Scores for Predicting Outcomes After Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8038-0378","authenticated-orcid":false,"given":"Aashray K.","family":"Gupta","sequence":"first","affiliation":[{"name":"Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Zaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daksh","family":"Tyagi","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Newcastle, Callaghan, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daud","family":"Mutahar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razeen","family":"Parvez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Muston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Farag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Lombardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Eranki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Wilson-Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gihwan","family":"Song","sequence":"additional","affiliation":[{"name":"School of Medicine, Deakin University, Burwood, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Stretton","sequence":"additional","affiliation":[{"name":"Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua G.","family":"Kovoor","sequence":"additional","affiliation":[{"name":"Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Bacchi","sequence":"additional","affiliation":[{"name":"Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Ramponi","sequence":"additional","affiliation":[{"name":"Yale University, New Haven, Connecticut, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin C. Y.","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Zaman","sequence":"additional","affiliation":[{"name":"Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Chow","sequence":"additional","affiliation":[{"name":"Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pramesh","family":"Kovoor","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayme S.","family":"Bennetts","sequence":"additional","affiliation":[{"name":"School of Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Department of Cardiothoracic Surgery, Victorian Heart Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy J.","family":"Maddern","sequence":"additional","affiliation":[{"name":"Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Australian Safety and Efficacy Register of New Interventional Procedures - Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia"},{"name":"Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2023.11.016"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.05.053"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs043"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.02.027"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx228"},{"key":"e_1_3_5_7_2","first-page":"81","volume-title":"Handbook of Structural Heart Interventions","author":"Raphael CE","year":"2020","unstructured":"Raphael CE, El Sabbagh A, Rihal C. 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