Beyond the Model: The Critical Role of Data Filtering in Clinical Machine Learning

We investigate data filtering for large model pretraining via new scaling studies that target the high compute, data-scarce regime. In spite of an apparently common belief that filtering data to include only high-quality information is essential, our experiments suggest that with enough compute, the best data filter is no data filter. We find that sufficiently trained large parameter models not only tolerate low-quality and distractor data, but in fact benefit from nominally ``poor'' data.

Postoperative adverse events, including mortality and morbidity, remain a major global burden, many of which are preventable through early identification of high-risk patients and targeted perioperative care. Accurate risk stratification is therefore essential. With the growing availability of large-scale electronic health records (EHRs), machine learning (ML) provides a data-driven approach to model complex clinical patterns. However, existing studies vary widely in design, and methodological practices remain fragmented. This scoping review characterizes ML pipelines for surgical risk stratification and outcome prediction using EHR data. We reviewed 190 studies covering the ML workflow, including data preprocessing, algorithm selection, model evaluation, and explainability. Most studies relied on single-center private datasets with limited data modalities, while the scarcity of open-access surgical datasets constrained reproducibility and generalizability. Reporting of key preprocessing steps, including missing data handling, feature selection, and class imbalance, was often incomplete. Conventional ML models and simple neural networks predominated, whereas deep learning and multimodal approaches remained uncommon. Benchmark datasets and standardized evaluation protocols were largely absent, hindering cross-study comparisons. Only about one-third of studies incorporated explainability methods. This review identifies methodological gaps limiting clinically robust postoperative ML tools and provides a structured reference to support more rigorous, reproducible, and clinically meaningful ML development for perioperative care.

Prior work evaluates code generation bias primarily through simple conditional statements, which represent only a narrow slice of real-world programming and reveal solely overt, explicitly encoded bias. We demonstrate that this approach dramatically underestimates bias in practice by examining a more realistic task: generating machine learning (ML) pipelines. Testing both code-specialized and general-instruction large language models, we find that generated pipelines exhibit significant bias during feature selection. Sensitive attributes appear in 87.7% of cases on average, despite models demonstrably excluding irrelevant features (e.g., including "race" while dropping "favorite color" for credit scoring). This bias is substantially more prevalent than that captured by conditional statements, where sensitive attributes appear in only 59.2% of cases. These findings are robust across prompt mitigation strategies, varying numbers of attributes, and different pipeline difficulty levels. Our results challenge simple conditionals as valid proxies for bias evaluation and suggest current benchmarks underestimate bias risk in practical deployments.