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Background Machine learning (ML) models are promising tools for predicting adverse postoperative outcomes in cardiac surgery, yet have not translated to routine clinical use. We conducted a systematic review and meta‐analysis to assess the predictive performance of ML approaches. Methods We conducted an electronic search to find studies assessing ML and traditional statistical models to predict postoperative outcomes. Our primary outcome was the concordance (C‐) index of discriminative performance. Using a Bayesian meta‐analytic approach we pooled the C‐indices with the 95% credible interval (CrI) across multiple outcomes comparing ML methods to logistic regression (LR) and clinical scoring tools. Additionally, we performed critical difference and sensitivity analysis. Results We identified 2792 references from the search of which 51 met inclusion criteria. Two postoperative outcomes were amenable for meta‐analysis: 30‐day mortality and in‐hospital mortality. For 30‐day mortality, the pooled C‐index and 95% CrI were 0.82 (0.79−0.85), 0.80 (0.77−0.84), 0.78 (0.74−0.82) for ML models, LR, and scoring tools respectively. For in‐hospital mortality, the pooled C‐index was 0.81 (0.78−0.84) and 0.79 (0.73−0.84) for ML models and LR, respectively. There were no statistically significant results indicating ML superiority over LR. Conclusion In cardiac surgery patients, for the prediction of mortality, current ML methods do not have greater discriminative power over LR as measured by the C‐index.

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