{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T06:42:38Z","timestamp":1776062558204,"version":"3.50.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Artif. Intell."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Canceled procedures in pediatric day-case surgery are a serious issue that can disrupt hospital workflow, resource utilization, and patient care. To better analyze this and explore strategies to mitigate such costly inefficiencies, we employed unsupervised machine learning (ML) techniques to analyze data from children undergoing day-case surgery at the Ospedale Pediatrico Bambino Ges\u00f9 IRCCS between January 2020 and March 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed a dataset including 4,417 operated and 183 non-operated patients. The following variables were considered: age, hospitalization type, surgical specialty, procedure type, and reasons for cancelation. Dimensionality reduction was performed using Factor Analysis of Mixed Data (FAMD). Cluster analysis was conducted using the k-means algorithm, while a Random Forest classifier was employed to assess feature importance and enhance model interpretability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall cancelation rate was 3.84%. Among operated patients, the median duration of surgery was 22\u202fmin (IQR: 12\u201332). For non-operated patients, the median waiting time from first consultation to the scheduled surgical procedure was 105\u202fdays (IQR: 58\u2013194). K-means clustering (\n                      <jats:italic>k<\/jats:italic>\n                      \u202f=\u202f3) identified three distinct patient groups, supported by robust clustering metrics (silhouette score: 0.696; Davies\u2013Bouldin index: 0.447; Calinski\u2013Harabasz score: 10,119.546). The Hopkins statistic (0.003) confirmed a strong clustering tendency in the dataset. Cluster 0 (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f2,010) was mainly characterized by plastic and maxillofacial procedures (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f765), andrological procedures (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f533), and pediatric urology surgeries (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f194), largely performed in an ambulatory setting (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,779). Cluster 1 (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,773) predominantly included andrological procedures (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f809) and showed the longest median intervention duration (27.01\u202fmin). Significant inter-cluster differences were observed for age (Kruskal\u2013Wallis test,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001 for clusters 0\u20131 and 1\u20132), surgical intervention rates (highest in Cluster 2: 97.92%;\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f10.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0063), and procedure duration (all pairwise Dunn tests\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Random Forest analysis identified hospitalization type (feature importance: 0.47) and procedure type (feature importance: 0.45) as the most influential variables contributing to cluster differentiation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The ML analysis may suggest targeted strategies for optimizing scheduling and resource allocation, ultimately improving patient care and operational efficiency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frai.2026.1743396","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:43:57Z","timestamp":1776059037000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unsupervised and explainable machine learning solutions for last-minute cancelations in pediatric ambulatory and day surgeries in Italy"],"prefix":"10.3389","volume":"9","author":[{"given":"Marco","family":"Cascella","sequence":"first","affiliation":[{"name":"Unit of Anesthesia and Pain Medicine, Department of Medicine, Surgery and Dentistry \u201cScuola Medica Salernitana\u201d, University of Salerno","place":["Baronissi, Salerno, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cosimo","family":"Guerra","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery, and Dentistry \u201cScuola Medica Salernitana\u201d, University of Salerno","place":["Baronissi, Salerno, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosario","family":"De Feo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery, and Dentistry \u201cScuola Medica Salernitana\u201d, University of Salerno","place":["Baronissi, Salerno, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Tarquini","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, ARCO, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Francia","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, ARCO, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Mascilini","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, ARCO, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia M.","family":"Pizzo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, ARCO, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Galeotti","sequence":"additional","affiliation":[{"name":"Dentistry Unit, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Caputo","sequence":"additional","affiliation":[{"name":"Dentistry Unit, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Pedone","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Campania Luigi Vanvitelli","place":["Caserta, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franco","family":"Marinangeli","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care, and Pain Treatment, University of L'Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Sabbatino","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Medicine, Surgery, and Dentistry, University of Salerno","place":["Baronissi, Salerno, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuliano","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Surgery Unit, Bios Medical Center","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corrado","family":"Cecchetti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, ARCO, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev S.","family":"Iyer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children\u2019s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine","place":["Philadelphia, PA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Vittori","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, ARCO, Ospedale Pediatrico Bambino Ges\u00f9 IRCCS","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"ref1","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0286312","DOI":"10.1371\/journal.pone.0286312","article-title":"Shape complexity in cluster analysis","volume":"18","author":"Aguilar","year":"2023","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jopan.2017.09.012","article-title":"Cancellation of surgeries: integrative 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