Evidence map›Paper›PMID 37578969›Full record

ArticlePLoS computational biology2023

Prediction of opioid-related outcomes in a medicaid surgical population: Evidence to guide postoperative opiate therapy and monitoring.

Oualid El Hajouji, Ran S Sun, Alban Zammit, Keith Humphreys, Steven M Asch, Ian Carroll, Catherine M Curtin, Tina Hernandez-Boussard

Abstract read
In one paragraph

Article in PLoS computational biology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Moving towards the use of artificial intelligence in pain management.European journal of pain (London, England) · 2025
    Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Oualid El HajoujiDepartment of Medicine, Stanford University, Stanford California, United States of America.
Ran S SunDepartment of Medicine, Stanford University, Stanford California, United States of America.
Alban ZammitDepartment of Medicine, Stanford University, Stanford California, United States of America.ORCID 0000-0002-2524-1113
Keith HumphreysCenter for Innovation to Implementation, Palo Alto Veterans Affairs Healthcare System, Palo Alto California, United States of America.
Steven M AschDepartment of Medicine, Stanford University, Stanford California, United States of America.
Ian CarrollDepartment of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford California, United States of America.
Catherine M CurtinDepartment of Surgery, VA Palo Alto Health Care System, Menlo Park California, United States of America.
Tina Hernandez-BoussardDepartment of Medicine, Stanford University, Stanford California, United States of America.ORCID 0000-0001-6553-3455

Funding

Advancing Knowledge Discovery for Postoperative Pain ManagementR01LM013362 · NLM · STANFORD UNIVERSITY · PI HERNANDEZ-BOUSSARD, TINA · 2019 to 2023
$3.2M
NLM NIH HHS R01 LM013362
6 · The paper itself

Abstract

backgroundTreatment of surgical pain is a common reason for opioid prescriptions. Being able to predict which patients are at risk for opioid abuse, dependence, and overdose (opioid-related adverse outcomes [OR-AE]) could help physicians make safer prescription decisions. We aimed to develop a machine-learning algorithm to predict the risk of OR-AE following surgery using Medicaid data with external validation across states.

methodsFive machine learning models were developed and validated across seven US states (90-10 data split). The model output was the risk of OR-AE 6-months following surgery. The models were evaluated using standard metrics and area under the receiver operating characteristic curve (AUC) was used for model comparison. We assessed calibration for the top performing model and generated bootstrap estimations for standard deviations. Decision curves were generated for the top-performing model and logistic regression.

resultsWe evaluated 96,974 surgical patients aged 15 and 64. During the 6-month period following surgery, 10,464 (10.8%) patients had an OR-AE. Outcome rates were significantly higher for patients with depression (17.5%), diabetes (13.1%) or obesity (11.1%). The random forest model achieved the best predictive performance (AUC: 0.877; F1-score: 0.57; recall: 0.69; precision:0.48). An opioid disorder diagnosis prior to surgery was the most important feature for the model, which was well calibrated and had good discrimination.

conclusionsA machine learning models to predict risk of OR-AE following surgery performed well in external validation. This work could be used to assist pain management following surgery for Medicaid beneficiaries and supports a precision medicine approach to opioid prescribing.

Indexed as

Analgesics, OpioidOpiate AlkaloidsHumansMedicaidPain ManagementPractice Patterns, Physicians'Retrospective StudiesAnalgesics, OpioidOpiate Alkaloids

Identifiers

PMID37578969
PMCPMC10449152

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.