Colleagues in orthopedics have made a point that translates directly to cardiac surgery: the most overhyped place to put AI is the operating room itself, and the most underrated places are the hours on either side of it.
The intraoperative moment is seductive because it is dramatic, but it is also the worst environment for an immature tool. The margins are seconds, the cost of error is catastrophic and the surgeon’s own pattern recognition is already extraordinarily good. AI earns its place in the OR slowly, on narrow tasks, with heavy validation. That work matters, but it is not where the early return lives and stays.
The early return lives in planning and in documentation. Surgical planning, case selection and risk stratification are where a well-validated model compresses hours of preparation and surfaces the patient who does not fit the standard pathway. Ambient documentation, done properly, gives a surgeon back the cognitive bandwidth that charting consumes, and reduces the burnout that is quietly draining the workforce.
In our program the same logic holds for the postoperative trajectory. Continuous physiological signal interpretation in the days after cardiac surgery, predicting the patient who is about to deteriorate before the vitals cross a threshold, is higher-value and lower-risk than anything I would let a model do with an instrument in my hand.
The lesson for hospital leaders evaluating surgical AI is to be skeptical of the OR demo and curious about the workflow. Ask where the tool removes friction and where it adds prediction outside the operative field. That is where the measurable return on investment is, and where the safety case is easiest to make.
Dr. Khalpey is chief medical AI officer at Atari AI, chair of applied clinical AI at the Atari AI Foundation and director of Khalpey AI Lab.
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