摘要Objective This study examines utilizes the advantages of machine learning algorithms to discern key determinants in prognosticate postoperative circulatory complications(PCCs)for older patients.Methods This secondary analysis of data from a randomized controlled trial involved 1,720 elderly participants in five tertiary hospitals in Beijing,China.Participants aged 60-90 years undergoing major non-cardiac surgery under general anesthesia.The primary outcome metric of the study was the occurrence of PCCs,according to the European Society of Cardiology and the European Society of Anaesthesiology diagnostic criteria.The analysis metrics contained 67 candidate variables,including baseline characteristics,laboratory tests,and scale assessments.Results Our feature selection process identified key variables that significantly impact patient outcomes,including the duration of ICU stay,surgery,and anesthesia;APACHE-Ⅱ score;intraoperative average heart rate and blood loss;cumulative opioid use during surgery;patient age;VAS-Move-Median score on the 1st to 3rd day;Charlson comorbidity score;volumes of intraoperative plasma,crystalloid,and colloid fluids;cumulative red blood cell transfusion during surgery;and endotracheal intubation duration.Notably,our Random Forest model demonstrated exceptional performance with an accuracy of 0.9872.Conclusion We have developed and validated an algorithm for predicting PCCs in elderly patients by identifying key risk factors.