# Developing Fairness-Aware Task Decomposition to Improve Equity in Post-Spinal Fusion Complication Prediction

arXiv: https://arxiv.org/abs/2512.00598 · HTML: https://mlsanity.com/paper/2512.00598/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 6 of its 34 references that are in the map.
- First posted on arXiv 29 Nov 2025.

## Builds on (most cited first, 6 of 6)

- [A Survey on Bias and Fairness in Machine Learning](https://mlsanity.com/paper/1908.09635/) (2019)
- [Fairness in Machine Learning: A Survey](https://mlsanity.com/paper/2010.04053/) (2020)
- [An Empirical Characterization of Fair Machine Learning For Clinical Risk Prediction](https://mlsanity.com/paper/2007.10306/) (2020)
- [SenSeI: Sensitive Set Invariance for Enforcing Individual Fairness](https://mlsanity.com/paper/2006.14168/) (2020)
- [Taking Advantage of Multitask Learning for Fair Classification](https://mlsanity.com/paper/1810.08683/) (2018)
- [Fair-MoE: Fairness-Oriented Mixture of Experts in Vision-Language Models](https://mlsanity.com/paper/2502.06094/) (2025)

## Built on by (most cited first, 1 of 1)

- [From Accuracy to Impact: The Impact-Driven AI Framework (IDAIF) for Aligning Engineering Architecture with Theory of Change](https://mlsanity.com/paper/2512.08449/) (2025)

## Abstract (arXiv)

Fairness in clinical prediction models remains a persistent challenge, particularly in high-stakes applications such as spinal fusion surgery for scoliosis, where patient outcomes exhibit substantial heterogeneity. Many existing fairness approaches rely on coarse demographic adjustments or post-hoc corrections, which fail to capture the latent structure of clinical populations and may unintentionally reinforce bias. We propose FAIR-MTL, a fairness-aware multitask learning framework designed to provide equitable and fine-grained prediction of postoperative complication severity. Instead of relying on explicit sensitive attributes during model training, FAIR-MTL employs a data-driven subgroup inference mechanism. We extract a compact demographic embedding, and apply k-means clustering to uncover latent patient subgroups that may be differentially affected by traditional models. These inferred subgroup labels determine task routing within a shared multitask architecture. During training, subgroup imbalance is mitigated through inverse-frequency weighting, and regularization prevents overfitting to smaller groups. Applied to postoperative complication prediction with four severity levels, FAIR-MTL achieves an AUC of 0.86 and an accuracy of 75%, outperforming single-task baselines while substantially reducing bias. For gender, the demographic parity difference decreases to 0.055 and equalized odds to 0.094; for age, these values reduce to 0.056 and 0.148, respectively. Model interpretability is ensured through SHAP and Gini importance analyses, which consistently highlight clinically meaningful predictors such as hemoglobin, hematocrit, and patient weight. Our findings show that incorporating unsupervised subgroup discovery into a multitask framework enables more equitable, interpretable, and clinically actionable predictions for surgical risk stratification.