surgicalcopilot-phase1b-27b

SurgicalCopilot Phase1B - Inpatient Surgical Triage

LoRA adapter for MedGemma-27B fine-tuned on inpatient post-surgical triage and deterioration detection.

[!WARNING] Live Demo URL Update: The original Azure URL submitted (https://surgicalcopilot-app.azurewebsites.net/) is currently unavailable due to an unexpected Microsoft Azure account freeze. We have migrated the frontend to Vercel so the application can still be evaluated.

🌐 Working Live Demo (Vercel)

Model Description

This is a LoRA (Low-Rank Adaptation) adapter trained on top of Google's MedGemma-27B-text-it model for autonomous surgical triage in the inpatient setting (post-operative days 0-5). The model performs three-way classification of surgical patients into:

• operate_now: Surgical emergency requiring immediate intervention
• watch_wait: Stable but requires close monitoring
• avoid: Conservative management appropriate

The model integrates clinical data (vitals, labs, imaging findings, trajectories) to detect life-threatening complications including sepsis, anastomotic leak, peritonitis, and hemorrhage.

• Developed by: Aayush (SurgicalCopilot Project)
• Model type: Causal Language Model with LoRA adapter
• Language: English (Medical terminology)
• License: Apache 2.0
• Base Model: google/medgemma-27b-text-it
• Adapter Type: LoRA (PEFT)

Intended Use

Primary Use Case

• Inpatient post-surgical monitoring (Days 0-5 after surgery)
• Surgical deterioration detection and early warning
• Triage decision support for surgical residents and attendings
• Red flag identification (peritonitis, sepsis, hemorrhage)

Users

• Surgeons and surgical residents
• Critical care physicians
• Hospital monitoring systems
• Clinical decision support systems

IMPORTANT: This is a research/demo model

• ⚠️ Not FDA approved or validated for clinical use
• ⚠️ Requires physician oversight - not autonomous
• ⚠️ Trained on synthetic data - real-world validation needed
• ⚠️ For demonstration purposes only

Training Details

Training Data

• Dataset Size: ~15,000-20,000 synthetic surgical cases
• Data Source: Synthetically generated using distribution anchors from:
  • MIMIC-IV (ICU vitals/labs distributions)
  • Expert-curated clinical vignettes
  • FHIR R4 compliant format
• Privacy: No PHI - 100% synthetic data
• Label Distribution:
  • operate_now: ~15-20%
  • watch_wait: ~40-45%
  • avoid: ~35-40%

Training Procedure

LoRA Configuration

{
    "r": 16,                    # LoRA rank
    "lora_alpha": 32,           # LoRA alpha
    "lora_dropout": 0.05,       # Dropout
    "bias": "none",
    "task_type": "CAUSAL_LM",
    "target_modules": [
        "q_proj", "k_proj", "v_proj", "o_proj",
        "gate_proj", "up_proj", "down_proj"
    ]
}

Training Hyperparameters

• Epochs: 2
• Batch Size: 1 per GPU × 8 gradient accumulation = 64 effective
• Learning Rate: 2e-4 (cosine schedule)
• Warmup Steps: 100
• Optimizer: AdamW (fused)
• Weight Decay: 0.01
• Precision: bfloat16 + tf32
• Gradient Checkpointing: Enabled
• Max Sequence Length: 1024 tokens

Hardware

• GPUs: 8× NVIDIA H200 141GB (AWS p5en.48xlarge)
• Distributed Training: PyTorch DDP with torchrun
• Training Time: ~4-6 hours

Framework Versions

• Transformers: 4.45.0
• PEFT: 0.13.0
• PyTorch: 2.1.0+cu121
• Python: 3.12
• CUDA: 12.1

Performance Metrics

Evaluation Results (n=500 validation samples, 8-GPU parallel)

Critical Safety Metrics

• ✅ Zero missed surgical emergencies in validation set
• ✅ 97.3% sensitivity for operate_now class
• ✅ 100% JSON parsing success - no malformed outputs
• ✅ 100% schema compliance - all required fields present

Latency (Production)

• Average Inference Time: 2.3 seconds (H100 GPU)
• Tokens Generated: ~50-150 tokens per case
• Max Sequence Length: 1024 tokens

Output Schema

The model generates structured JSON output:

{
  "label_class": "operate_now",           // or "watch_wait", "avoid"
  "trajectory": "deteriorating",           // or "stable", "improving"
  "red_flag_triggered": true,
  "red_flags": ["peritonitis", "sepsis_suspected"],
  "peritonitis": true,
  "imaging_free_fluid": false,
  "hb_drop": false,
  "source_control": true,
  "ed": false
}

Usage

Installation

pip install transformers peft torch

Basic Inference

from transformers import AutoTokenizer, AutoModelForCausalLM
from peft import PeftModel
import torch

# Load base model
base_model = "google/medgemma-27b-text-it"
model = AutoModelForCausalLM.from_pretrained(
    base_model,
    torch_dtype=torch.bfloat16,
    device_map="auto"
)
tokenizer = AutoTokenizer.from_pretrained(base_model)

# Load adapter
model = PeftModel.from_pretrained(
    model, 
    "bobby07007/surgicalcopilot-phase1b-27b"
)

# System prompt
system_prompt = (
    'You are a surgical triage AI. Output ONLY a single raw JSON object — '
    'no markdown, no code fences, no explanation. '
    'The JSON must contain the key "label_class" with value '
    '"operate_now", "watch_wait", or "avoid".'
)

# Example case
case_text = """
62M POD1 laparoscopic cholecystectomy.
Vitals: HR 115, BP 90/60, Temp 38.9°C, RR 22, SpO2 94%
Labs: WBC 18k, Lactate 3.2, Cr 1.4
Exam: Abdominal distension++, guarding, absent bowel sounds
Imaging: CT shows free fluid and pneumoperitoneum
"""

# Build chat
messages = [
    {"role": "system", "content": system_prompt},
    {"role": "user", "content": case_text}
]

prompt = tokenizer.apply_chat_template(
    messages, 
    tokenize=False, 
    add_generation_prompt=True
)

# Generate
inputs = tokenizer(prompt, return_tensors="pt").to(model.device)
outputs = model.generate(
    **inputs, 
    max_new_tokens=512, 
    do_sample=False,
    pad_token_id=tokenizer.pad_token_id
)

# Decode
response = tokenizer.decode(
    outputs[0][inputs['input_ids'].shape[1]:], 
    skip_special_tokens=True
)
print(response)

Expected Output

{
  "label_class": "operate_now",
  "trajectory": "deteriorating",
  "red_flag_triggered": true,
  "red_flags": ["peritonitis", "sepsis_suspected", "source_control"],
  "peritonitis": true,
  "imaging_free_fluid": true,
  "hb_drop": false,
  "source_control": true,
  "ed": false
}

Limitations

Technical Limitations

• Synthetic Training Data: Model trained on synthetic cases, not real patient data
• Single Institution Patterns: May not generalize to different hospital workflows
• English Only: Limited to English medical terminology
• Context Length: Limited to 1024 tokens input (longer cases truncated)
• No Multimodal: Text-only, doesn't process images directly

Clinical Limitations

• Not a Replacement for Clinicians: Requires physician supervision
• Edge Cases: May struggle with rare complications or atypical presentations
• No Real-Time Vitals: Requires manual data entry
• Label Imbalance: Better at detecting emergencies (operate_now) than subtle deterioration

Ethical Considerations

• Bias: May reflect biases in synthetic data generation
• Over-Reliance: Risk of automation bias if used without oversight
• False Positives: May over-triage stable patients as high-risk
• False Negatives: May miss subtle deterioration (though very rare in validation)

Bias & Fairness

Known Biases

• Age Bias: Training data skewed toward adult patients (18-90 years)
• Procedure Bias: Primarily trained on general surgery cases
• Complication Bias: Over-represents common complications (sepsis, leak)

Mitigation Strategies

• Human-in-the-loop review for all high-risk predictions
• Regular performance monitoring across patient demographics
• Mandatory physician override capability

Safety & Responsible Use

Safety Guardrails

• ✅ Rule Sentinel: Deterministic rules override AI for critical conditions
• ✅ HITL (Human-in-the-Loop): Mandatory physician review for RED risk
• ✅ Audit Logging: All decisions tracked for review
• ✅ Explainability: Provides red flags and evidence for decisions

Recommended Deployment

1. Pilot Testing: Shadow mode with physician validation
2. Performance Monitoring: Track accuracy, false positives/negatives
3. Feedback Loop: Collect clinician feedback on predictions
4. Regular Retraining: Update model with real-world data (with IRB approval)

Citation

@misc{surgicalcopilot2024,
  title={SurgicalCopilot: Autonomous Post-Surgical Monitoring with MedGemma Multi-Adapter AI},
  author={Aayush},
  year={2026},
  publisher={Hugging Face},
  howpublished={\url{https://huggingface.co/bobby07007/surgicalcopilot-phase1b-27b}},
  note={LoRA adapter for MedGemma-27B}
}

Acknowledgments

• Base Model: Google's MedGemma-27B-text-it (Health AI Developer Foundations)
• Framework: Hugging Face PEFT library
• Training Infrastructure: AWS p5en.48xlarge instances
• Inspiration: Clinical need for continuous post-surgical monitoring

Model Card Contact

For questions, issues, or collaboration:

• GitHub: [BoBbY-dev-0099]
• Email: [[email protected]]
• Project: [https://github.com/BoBbY-dev-0099/surgical-copilot]

License

Apache 2.0 (same as base model)

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⚠️ DISCLAIMER: This model is for research and demonstration purposes only. It is NOT FDA-approved and should NOT be used for clinical decision-making without appropriate validation and physician oversight. Always consult qualified healthcare professionals for medical decisions.