• Parisa Sezari, Zeinab Kohzadi, Ali Dabbagh, Alireza Jafari, Saba Khoshtinatan, Kamran Mottaghi, Zahra Kohzadi, and Shahabedin Rahmatizadeh.
• Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
• BMC Anesthesiol. 2024 Dec 18; 24 (1): 453453.

BackgroundTo protect patients during anesthesia, difficult airway management is a serious issue that needs to be carefully planned for and carried out. Machine learning prediction tools have recently become increasingly common in medicine, frequently surpassing more established techniques. This study aims to utilize machine learning techniques on predictive parameters for challenging airway management.MethodsThis study was cross-sectional. The Shahid Beheshti University of Medical Sciences in Iran's Loghman Hakim and Shahid Labbafinezhad hospitals provided 622 records in total for analysis. Using the forest of trees approach and feature importance, important features were chosen. The Synthetic Minority Oversampling Technique (SMOTE) and repeated edited nearest neighbor under-sampling were used to balance the data. Using Python and 10-fold cross-validation, seven machine learning algorithms were assessed: Logistic Regression, Support Vector Machines (SVM), Random Forest (INFORMATION-GAIN and GINI-INDEX), Decision Tree, and K-Nearest Neighbors (KNN). Metrics like F-measure, AUC, Recall, Accuracy, Specificity, and Precision were used to evaluate the performance of the model.ResultsTwenty-four important features were chosen from the original 32 features. The under-sampling strategy produced better results than SMOTE. Among the algorithms, KNN (Euclidean, Minkowski) had better performance than other algorithms. The highest values ​​for accuracy, precision, recall, F-measure, and AUC were obtained at 0.87, 0.88, 0.82, 0.85, and 0.87, respectively.ConclusionAlgorithms for machine learning provide insightful information for anticipating challenging airway management. By making it possible to forecast airway difficulties more accurately, these techniques can potentially improve clinical practice and patient outcomes.© 2024. The Author(s).

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