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arXiv · 2601.13710

Who Benefits From Sinus Surgery? Comparing Generative AI and Supervised Machine Learning for Predicting Surgical Outcomes in Chronic Rhinosinusitis

Sayeed Shafayet Chowdhury·Snehasis Mukhopadhyay·Shiaofen Fang·Vijay R. Ramakrishnan
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Abstract

Artificial intelligence has reshaped medical imaging, yet the use of AI on clinical data for prospective decision support remains limited. We study pre-operative prediction of clinically meaningful improvement in chronic rhinosinusitis (CRS), defining success as a more than 8.9-point reduction in SNOT-22 at 6 months (MCID). In a prospectively collected cohort where all patients underwent surgery, we ask whether models using only pre-operative clinical data could have identified those who would have poor outcomes, i.e. those who should have avoided surgery. We benchmark supervised ML (logistic regression, tree ensembles, and an in-house MLP) against generative AI (ChatGPT, Claude, Gemini, Perplexity), giving each the same structured inputs and constraining outputs to binary recommendations with confidence. Our best ML model (MLP) achieves 85 % accuracy with superior calibration and decision-curve net benefit. GenAI models underperform on discrimination and calibration across zero-shot setting. Notably, GenAI justifications align with clinician heuristics and the MLP's feature importance, repeatedly highlighting baseline SNOT-22, CT/endoscopy severity, polyp phenotype, and physchology/pain comorbidities. We provide a reproducible tabular-to-GenAI evaluation protocol and subgroup analyses. Findings support an ML-first, GenAI- augmented workflow: deploy calibrated ML for primary triage of surgical candidacy, with GenAI as an explainer to enhance transparency and shared decision-making.

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Sayeed Shafayet Chowdhury, Snehasis Mukhopadhyay, Shiaofen Fang, Vijay R. Ramakrishnan. 2026-01-20. Who Benefits From Sinus Surgery? Comparing Generative AI and Supervised Machine Learning for Predicting Surgical Outcomes in Chronic Rhinosinusitis. https://arxiv.org/abs/2601.13710

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