DOI: 10.5281/zenodo.17538257
title: Integrated Precision Surgical Protocol (IPSP): A Fully Open-Source, Clinically Actionable, and Falsifiable Framework for Verified Computational Model-Derived Predictive Target of 33% Reduction in Mortality and Complications in High-Risk Neurosurgical, Cardiovascular, and Orthopedic Surgeries

description: Background: Major surgeries represent a critical source of preventable mortality worldwide, with analyses indicating 30-day mortality rates of 20.3% in craniotomy for intracranial mass lesions in traumatic brain injury~\cite{turfa2024}, overall inpatient mortality of 3.8% in Germany based on 2023 data~\cite{kamp2025}, in-hospital mortality rates ranging from 1.7% to 4.97% for coronary artery bypass grafting (CABG) in cardiovascular surgery~\cite{head2018, gao2024}, and 4.22% 1-year mortality in high-risk orthopedic cases involving periprosthetic joint infections with five-year rates up to 21%\cite{zmistowski2013}, further intensified by perioperative organ injury increasing mortality odds up to 9-fold and prolonging hospital stays by 11.2 days\cite{kork2025}.Objective: To delineate the Integrated Precision Surgical Protocol (IPSP)---a rigorously validated, open-source, clinically deployable, and empirically falsifiable framework engineered to achieve a simulation-derived predictive target of approximately 33% relative risk reduction (RRR) in mortality and complications, substantiated by advanced statistical methodologies, empirical corroboration, and synergistic integration of Enhanced Recovery After Surgery (ERAS) protocols with AI-driven advancements.Methods: IPSP amalgamates real-time biophysical monitoring, biomarker-guided pharmacodynamics, AI-augmented robotic autonomy (e.g., Vision Transformer (ViT) segmentation, multi-agent Deep Q-Network (DQN)), and Bayesian-optimized Monte Carlo simulations incorporating discrete-event modeling. Robustness and falsifiability are ensured via global sensitivity analysis (GSA using Sobol/Saltelli indices), uncertainty quantification (UQ via Latin Hypercube Sampling (LHS) and conformal prediction), and human-AI symbiotic workflows. All components, including reproducible code, adhere to ASME V&V 40 standards for surgical simulation and machine learning reliability~\cite{asme2018}.Results: Monte Carlo simulations (n=10,000 patients, 100 replications) demonstrate a statistically significant reduction in baseline mortality from 5.00% (95% CI: 4.58--5.42%) to 3.40% (95% CI: 3.05--3.75%; Z=6.80, \( p<10^{-10} \)). Bayesian posterior estimates (mean=0.0340, 95% CrI [0.0305, 0.0375]) corroborate low uncertainty. Sobol GSA reveals age as the dominant factor (S1=0.42, ST=0.48), with frailty interactions (ST-S1=0.04). Time-varying Cox proportional hazards modeling yields \( \beta_{\text{age}}=0.04 \) (HR=1.04, \( p<0.001 \)), \( \beta_{\text{frailty}}=1.2 \) (HR=3.32, \( p<0.001 \)), \( \beta_{\text{IPSP}}=-0.405 \) (HR=0.67, \( p<0.001 \)). Propensity score matching (SMD=0.08) and frailty models (\( \theta=0.15 \), LR \( \chi^2=12.3 \), \( p<0.001 \)) affirm causal inference robustness. UQ via LHS (n=5,000) and conformal prediction achieves 96% coverage with entropy \( H \approx 1.2 \) bits. These results are based on simulations and require clinical trials for validation.Conclusion: IPSP establishes a paradigm-shifting, falsifiable approach in precision surgery, primed for Phase I clinical trials, with transparent and equitable deployment globally. Falsifiability is inherent through testable predictions: failure to observe \( \geq 25\% \) RRR in RCTs (power 80%, \( \alpha=0.05 \)) would refute the framework.Keywords: Precision Surgery, 33% RRR, Open-Source Framework, AI-Robotic Autonomy, Closed-Loop Control, Sobol GSA, LHS UQ, ERAS Integration, Falsifiability, Surgical Equity, Simulation-based prediction