Ana R\u00edos \u00b7 54F

MRN JP-042\u202f7713 Hub Medell\u00edn Procedure Total hip replacement Target date Apr 24, 2026

Overall complication risk

7.4%

Moderate \u00b7 CI 5.8\u20139.1%

Cohort comparison

+1.2pp

Above age-matched cohort baseline

Model confidence

High

N = 11\u202f840 cases \u00b7 AUC 0.83

Risk posture

Optimizable

3 modifiable drivers identified

Predicted 30-day complication risk

Orthopedics \u00b7 Total hip replacement

Moderate

7.4^%

95% CI 5.8\u20139.1

Ana is +1.2pp above the age-matched THR baseline (6.2%), driven by BMI 28.4 and diabetes. 3 modifiable drivers \u2014 pre-op A1c, VTE prophylaxis, nutritional optimization \u2014 can return her to the low-risk band.

Surg. infection

2.6%

VTE / DVT

2.8%

Readmission

5.3%

Reoperation

1.3%

Mortality

0.14%

Extended LOS

7.6%

Longitudinal risk monitor

Pre-op \u2192 post-op. Each stage rescored from ingested evidence.

Live

Day \u201330 \u00b7 Baseline Screening stage

Initial risk score generated from Passport dossier (self-report + EMR summary).
Flagged: BMI 29.1, A1c 7.2%, self-reported occasional smoker (6 cig/week).
Scheduler routed to ortho pre-op optimization pathway; pre-habilitation program enrolled.
Workup ordered: pre-op A1c, TTE, anemia panel, nutrition consult.

Recommended workup

Driver-matched orders. Override any item from the chart.

Pre-op HbA1c within 30 days \u2014 target < 7.0%Glycemic

Anemia panel + iron studies \u2014 optimize if Hgb < 12Nutrition

TTE (baseline) \u2014 ECG + basic echo screenCardiac

VTE chemoprophylaxis plan \u2014 surgeon \u00d7 hospitalistVTE

Smoking cessation \u2014 4-week pre-op abstinence documentedModifiable

Dental evaluation \u2014 cleared for implantSSI

Patient inputs

Hot-editable. Live rescore on change.

Procedure

Age \u2014 54 yrs

18406085

BMI \u2014 28.4 kg/m\u00b2

UnderNormalOverClass III

Comorbidities

Functional status

Counterfactual workup

Smallest set of pre-op interventions that change the outcome · auto-creates Pathway tasks.

Risk Engine v2.4.1

If patient achieves all 5 levers by surgery date

Combined risk reduction

Optimizer picks the smallest set of interventions that materially shifts the score for this patient. Each becomes a Pathway task with owner, deadline, and adherence tracking.

8.4% → 3.1% −5.3 pts · complication probability

Glycemic control: A1c < 7.0% by surgery date (current 8.2%)

Endocrine Owner: Dr. Patel · PCP Deadline: 5 weeks pre-op Confidence 91%

Why: Each 1-pt drop in A1c reduces 30-day infection risk ~22% in the network's THR cohort (n=2,840). Recommended: CGM + dietitian touch + 2× telehealth checks.

8.4%→ 4.1%−4.3 pts

Smoking cessation: 0 cigarettes for 6 weeks pre-op (current 8/day)

Pulmonary Owner: Sofía · Coordinator Deadline: 6 weeks pre-op Confidence 88%

Why: Active smoking at OR doubles the 30-day wound dehiscence risk in the cohort. Plan: nicotine replacement + behavioral support, weekly cotinine reads.

8.4%→ 5.6%−2.8 pts

Iron repletion: ferritin > 100 ng/mL pre-op (current 32)

Hematology Owner: Dr. Castaño · Surgeon Deadline: 3 weeks pre-op Confidence 84%

Why: Pre-op iron deficiency is independently associated with a 37% higher transfusion rate. Recommended: oral ferrous sulfate 325 mg TID + vit C, ferritin recheck at 3 weeks.

8.4%→ 7.1%−1.3 pts

Pre-habilitation: 30 min/day low-impact for 4 weeks (current sedentary)

PT & conditioning Owner: Local PT partner Deadline: 4 weeks pre-op Confidence 79%

Why: 4-week prehab predicts 6-day faster mobilization and 22% lower 30-day readmission in the cohort. Plan: Pathway-issued PT plan + step-count tracking from Apple Health.

8.4%→ 7.4%−1.0 pt

Med rationalization: hold NSAIDs 7d pre-op · bridge to ASA

Pharmacology Owner: Dr. Patel · PCP Deadline: 1 week pre-op Confidence 95%

Why: Active NSAID use at OR raises bleeding risk and conflicts with enoxaparin protocol. Auto-flagged in Med Reconciliation. Bridge plan included.

8.4%→ 8.0%−0.4 pt

Levers proposed

2 P1 · 2 P2 · 1 P3

Combined risk delta

−5.3 pts

From 8.4% → 3.1%

Realized at discharge

Awaiting

Re-quantified post-op

Risk drivers

Shapley-style decomposition \u00b7 sorted by magnitude

BMI 28.4

+1.7

Diabetes

+1.2

Active smoker

+0.9

Hypertension

+0.5

Independent status

\u20130.4

Age 54

+0.4

Recent activity

Model updates, overrides, cohort changes

Risk rescored after A1c result 7.2% \u2192 6.8%

2h ago

Nutrition consult note ingested iron deficiency resolved

1d ago

Flag raised \u00b7 smoking not confirmed abstinent

2d ago

Model v2.4.1 re-cohorted \u00b7 Medell\u00edn THR +1 842 cases

3d ago

Initial risk score generated \u00b7 screening

30d ago

This score is decision-support, not a directive.

Override any recommendation with a documented reason \u2014 it flows to the audit trail and feeds back into the next retraining cycle. Every patient brief ships with model version, input hash, and confidence interval.

Clinical dashboard

Network-wide risk posture across every active patient in the pre-op and post-op windows. Drill into any tile.

Active encounters

Ana Ríos · THR · Day −3

Pre-op queue

8 ortho · 9 bariatric · 5 cardiac · 2 cosmetic

Post-op monitor

12 in hub · 45 on handback

Flags & alerts

2 urgent · 1 standard

Model in production

v2.4.1

Retrained 2 days ago · AUC 0.83

30-day complication rate

4.2%

vs. 6.1% US benchmark

Pre-op queue

Every patient currently in the optimization window. Sorted by surgical date. Click any row to open the encounter.

Patient	Procedure	Hub	Surgery	Risk	Drivers
Ana Ríos · 54F	THR	Medellín	Apr 24	7.4%	BMI · A1c · smoking
C. Pinto · 62M	TKR	Medellín	Apr 27	6.8%	BMI · HTN
M. Guerrero · 44F	Sleeve	Mexico City	Apr 28	3.9%	A1c
D. Silva · 58M	CABG	Istanbul	May 2	14.2%	CAD · CKD · BMI
L. Chen · 36F	ACL	Mexico City	May 4	2.1%	Modifiable: none
R. Aydın · 51M	TAVR	Istanbul	May 6	12.4%	Age · CKD
J. Morales · 48F	RYGB	Medellín	May 8	8.2%	DM · OSA
S. Okafor · 39F	BBL	Medellín	May 11	2.8%	Smoking

Post-op monitor

Patients in active recovery. Risk Engine rescores each new data point streaming in from hub or handback.

Patient	Day post-op	Stage	Current risk	Δ from baseline	Status
K. Nakamura	Day +4	Hub recovery	2.2%	−4.8 pp	On plan
P. Ortega	Day +12	PCP handback	1.1%	−7.0 pp	On plan
B. Reddy	Day +6	Hub recovery	5.4%	−1.2 pp	Watch · ↓ mobility
T. Faulkner	Day +28	Follow-up	0.8%	−5.3 pp	On plan
I. Volkov	Day +2	Hub recovery	6.6%	−2.4 pp	Watch · wound check

Flags & alerts

Clinical signals requiring clinician review. Auto-raised by Risk Engine when an ingest triggers a drift against the planned trajectory.

Patient	Flag	Severity	Raised	Owner
Ana Ríos	Smoking not confirmed abstinent	Urgent	2d ago	Pre-op RN
D. Silva	Creatinine trending up	Urgent	1d ago	Cardiology
B. Reddy	Mobility below target at Day +6	Standard	4h ago	PT lead

Risk models

Production and candidate models. Every prediction ships with a model-version stamp, feature set hash, and confidence interval.

Model	Version	Status	AUC	N cases	Last retrained
Ortho 30-day complication	v2.4.1	Production	0.83	11 840	2 days ago
Bariatric 30-day complication	v1.7.3	Production	0.81	6 210	6 days ago
Cardiac 30-day complication	v1.2.0	Production	0.78	3 480	11 days ago
Ortho 90-day readmission	v0.9.4	Candidate	0.76	8 120	1 day ago
Multimodal travel risk	v0.6.1	R&D	0.71	3 040	4 days ago

Cohort analytics

Rolling analytical cohorts sliced by procedure, hub, and comorbidity class. Use to benchmark an individual patient against peers.

Medellín · THR

1 842

SSI 1.9% · readmit 4.1% · mortality 0.10%

Medellín · TKR

1 566

SSI 1.8% · readmit 3.8% · mortality 0.08%

Mexico City · Sleeve

920

SSI 1.4% · readmit 3.2% · mortality 0.05%

Istanbul · CABG

410

SSI 2.9% · readmit 7.2% · mortality 0.94%

Istanbul · TAVR

268

SSI 1.6% · readmit 6.8% · mortality 1.10%

US benchmark · THR

—

SSI 2.4% · readmit 5.0% · mortality 0.12%

Performance

Model calibration and discrimination tracked week-over-week. Drift is monitored against both rolling cohort and US reference.

Discrimination (AUC)

0.83

Ortho 30-day · +0.02 vs. prior

Calibration slope

0.98

Close to ideal (1.00)

Brier score

0.061

Lower is better

Decision yield

+17%

Override rate on high-risk cohort

Audit trail

Every prediction, override, and model retraining event is immutable and queryable. Full feature set and signing key retained for 10 years.

Time	Actor	Event	Patient	Model
2h ago	system	Rescore after A1c result	Ana Ríos	v2.4.1
6h ago	Dr. Rivera	Override: recommended discharge Day 1 → Day 2	P. Ortega	v2.4.1
1d ago	system	Ingest: nutrition consult note	Ana Ríos	v2.4.1
2d ago	Dr. Hwang	PCP handback acknowledged	T. Faulkner	v2.4.1
3d ago	ML ops	Model v2.4.1 promoted to production	—	v2.4.1

Settings

Workspace preferences for the clinical prototype.

Default procedure family

Orthopedics

Applies to new encounters

Alert threshold

≥ 10% 30-day

Override per-patient from the chart

EHR integration

FHIR R4

Epic / Cerner / Athena

Language

English

Auto-translates patient-facing content