# Who Benefits From Sinus Surgery? Comparing Generative AI and Supervised Machine Learning for Predicting Surgical Outcomes in Chronic Rhinosinusitis

arXiv: https://arxiv.org/abs/2601.13710 · HTML: https://mlsanity.com/paper/2601.13710/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 3 of its 19 references that are in the map.
- First posted on arXiv 20 Jan 2026.

## Builds on (most cited first, 3 of 3)

- [Language Models (Mostly) Know What They Know](https://mlsanity.com/paper/2207.05221/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Scalable and accurate deep learning for electronic health records](https://mlsanity.com/paper/1801.07860/) (2018)

## Abstract (arXiv)

Artificial intelligence has reshaped medical imaging, yet the use of AI on clinical data for prospective decision support remains limited. We study pre-operative prediction of clinically meaningful improvement in chronic rhinosinusitis (CRS), defining success as a more than 8.9-point reduction in SNOT-22 at 6 months (MCID). In a prospectively collected cohort where all patients underwent surgery, we ask whether models using only pre-operative clinical data could have identified those who would have poor outcomes, i.e. those who should have avoided surgery. We benchmark supervised ML (logistic regression, tree ensembles, and an in-house MLP) against generative AI (ChatGPT, Claude, Gemini, Perplexity), giving each the same structured inputs and constraining outputs to binary recommendations with confidence. Our best ML model (MLP) achieves 85 % accuracy with superior calibration and decision-curve net benefit. GenAI models underperform on discrimination and calibration across zero-shot setting. Notably, GenAI justifications align with clinician heuristics and the MLP's feature importance, repeatedly highlighting baseline SNOT-22, CT/endoscopy severity, polyp phenotype, and physchology/pain comorbidities. We provide a reproducible tabular-to-GenAI evaluation protocol and subgroup analyses. Findings support an ML-first, GenAI- augmented workflow: deploy calibrated ML for primary triage of surgical candidacy, with GenAI as an explainer to enhance transparency and shared decision-making.