Predicting Intraoperative Hypotension Using Machine Learning: A Comprehensive Analysis of the MOVER Dataset

Intraoperative hypotension (IOH) is a critical complication during surgical procedures that can lead to severe adverse outcomes including myocardial injury, acute kidney injury, and increased mortality. Early prediction of hypotensive events remains a significant challenge in perioperative medicine. This study leverages the Medical Informatics Operating Room Vitals and Events Repository (MOVER) dataset, a comprehensive collection of intraoperative physiological signals and clinical events, to develop and evaluate machine learning models for predicting hypotensive events 5, 10, and 15 minutes before onset.The MOVER dataset contains high-frequency vital sign measurements including heart rate, blood pressure, oxygen saturation, and respiratory metrics from over 5,000 surgical procedures. Extensive preprocessing and feature engineering were performed to extract statistical, temporal, and interaction features across multiple time windows. Multiple machine learning algorithms were implemented and compared including XGBoost, Random Forest, Histogram-based Gradient Boosting (HGB), Support Vector Machines (SVM) with RBF kernel, Long Short-Term Memory (LSTM) networks, Multilayer Perceptron (MLP), and K-Nearest Neighbors (KNN).Experimental results demonstrate that XGBoost achieves the highest predictive performance with an accuracy of 94.2%, precision of 93.8%, recall of 94.5%, and AUC-ROC of 0.973 for 5-minute prediction windows. Performance remained strong for 10-minute (AUC-ROC = 0.942) and 15-minute (AUC-ROC = 0.908) predictions. Feature importance analysis revealed that mean arterial pressure (MAP) trends, heart rate variability, shock index, and time since last vasopressor administration were the most significant predictors. Error analysis identified borderline MAP values and rapid hemodynamic changes as primary sources of misclassification.The proposed models demonstrate strong potential for real-time clinical decision support systems to alert anesthesiologists of impending hypotensive events, enabling proactive interventions and improved patient outcomes. This research represents the first comprehensive comparison of multiple machine learning algorithms on the MOVER dataset for hypotension prediction, providing a foundation for future clinical implementation and prospective validation studies.