Given the sheer volume of surgical procedures and the significant rate of postoperative fatalities, assessing and managing surgical complications has become a critical public health concern. Existing artificial intelligence (AI) tools for risk surveillance and diagnosis often lack adequate interpretability, fairness, and reproducibility. To address this, we proposed an Explainable AI (XAI) framework designed to answer five critical questions: why, why not, how, what if, and what else, with the goal of enhancing the explainability and transparency of AI models. We incorporated various techniques such as Local Interpretable Model-agnostic Explanations (LIME), SHapley Additive exPlanations (SHAP), counterfactual explanations, model cards, an interactive feature manipulation interface, and the identification of similar patients to address these questions. We showcased an XAI interface prototype that adheres to this framework for predicting major postoperative complications. This initial implementation has provided valuable insights into the vast explanatory potential of our XAI framework and represents an initial step towards its clinical adoption.

鉴于手术操作的规模庞大和术后死亡率的显著高位，评估和管理手术并发症已成为一个重要的公共卫生问题。为了解决现有人工智能工具在风险监测和诊断方面缺乏适当的可解释性、公平性和可复现性的问题，我们提出了一个解释性人工智能（XAI）框架，旨在回答为什么、为何不、如何、如果以及其他问题，目标是提高人工智能模型的可解释性和透明度。我们融合了各种技术，如局部可解释的模型无关解释（LIME）、SHapley Additive Explanation（SHAP）、反事实解释、模型卡片、交互式特征操作界面以及相似患者的识别来解决这些问题。我们展示了一个遵循这一框架用于预测术后重大并发症的XAI界面原型。这个初始实现为我们的XAI框架的广阔解释潜力提供了有价值的见解，并代表了朝着其临床应用迈出的初步一步。

透明人工智能：为预测术后并发症开发可解释界面