Federated Bayesian Surveillance of Mechanical Thrombectomy Adverse Events: A Population Risk Layer for Surgical Digital Twins

Learned surgical simulators and world models can roll out plausible procedural futures, but they carry no grounded estimate of how often interventional devices actually harm patients. We propose treating population-scale adverse-event surveillance as a distinct belief layer of the surgical digital twin, and we evaluate a federated Bayesian protocol for learning it under formal privacy guarantees. Each site holds per-class Gamma-Poisson posteriors over adverse-event rates and exchanges only R'enyi-differentially-private natural-parameter updates. We benchmark on the complete FDA MAUDE cohort for thrombus-retrieval catheters (product code NRY): 8,617 reports, of which 6,491 are classified by transparent keyword rules into five thrombectomy complication classes and partitioned across K=8 manufacturer sites. At a matched privacy budget of (varepsilon ≈ 2.09, δ = 10-5), the conjugate protocol attains a held-out Poisson score of -5.78 per test event versus -26.58 for FedAvg with differential privacy. The non-private federated model also outperforms centralized pooling (+3.19 vs +2.93), evidence that manufacturer-specific complication profiles are real and that federation preserves them. Because MAUDE lacks procedure denominators, outputs are relative rate orderings rather than absolute risks, and we report all privacy-utility operating points.