ArticleBJA open2026
Integrating machine learning and pathway modelling to explore factors associated with chronic post-surgical pain and quality of life: a secondary observational analysis of the ENIGMA-II trial.
Article in BJA open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00430989 (Large, Randomised, Parallel-group, Controlled Trial, With Patients Randomly Allocated to Either N2O-containing), which is not on this map. Not yet cited in PubMed.
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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.
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Large, Randomised, Parallel-group, Controlled Trial, With Patients Randomly Allocated to Either N2O-containing (70% N2O in Oxygen [FiO2 0.3]) or N2O-free (70% Nitrogen in Oxygen [FiO2 0.3]).
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10 authors.
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Abstract
Background: Chronic post-surgical pain (CPSP) is a common long-term complication with multifactorial contributors, and improved risk stratification remains a clinical priority. This study aimed to identify factors associated with CPSP and related outcomes and to explore hypothesised multivariable pathways using a hybrid analytical approach. Methods: We performed a secondary observational analysis of 2999 participants from the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II CPSP substudy with 12-month postoperative assessment. Grouped lasso (GLASSO) was used for penalised feature selection across prespecified predictor groups, and partial least squares structural equation modelling (PLS-SEM) was applied within a theory-informed framework to explore associations among measured domains and outcomes. Analyses were exploratory and did not establish causal effects. Results: GLASSO models showed moderate discrimination/explanatory power (CPSP area under the curve 0.69, 95% confidence interval 0.64-0.74; EQ-5D R Conclusions: A GLASSO-PLS-SEM workflow provided an exploratory approach to identifying key features and mapping hypothesised multivariable associations in CPSP-related outcomes. External validation and richer psychosocial/structural measures are needed before clinical translation. Trial registration: ClinicalTrials.gov NCT00430989.
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