Development and Validation of a Model for Opioid Prescribing Following Gynecological Surgery.

dc.contributor.author

Rodriguez, Isabel V

dc.contributor.author

Cisa, Paige McKeithan

dc.contributor.author

Monuszko, Karen

dc.contributor.author

Salinaro, Julia

dc.contributor.author

Habib, Ashraf S

dc.contributor.author

Jelovsek, J Eric

dc.contributor.author

Havrilesky, Laura J

dc.contributor.author

Davidson, Brittany

dc.date.accessioned

2023-06-01T13:37:29Z

dc.date.available

2023-06-01T13:37:29Z

dc.date.issued

2022-07

dc.date.updated

2023-06-01T13:37:28Z

dc.description.abstract

Importance

Overprescription of opioid medications following surgery is well documented. Current prescribing models have been proposed in narrow patient populations, which limits their generalizability.

Objective

To develop and validate a model for predicting outpatient opioid use following a range of gynecological surgical procedures.

Design, setting, and participants

In this prognostic study, statistical models were explored using data from a training cohort of participants undergoing gynecological surgery for benign and malignant indications enrolled prospectively at a single institution's academic gynecologic oncology practice from February 2018 to March 2019 (cohort 1) and considering 39 candidate predictors of opioid use. Final models were internally validated using a separate testing cohort enrolled from May 2019 to February 2020 (cohort 2). The best final model was updated by combining cohorts, and an online calculator was created. Data analysis was performed from March to May 2020.

Exposures

Participants completed a preoperative survey and weekly postoperative assessments (up to 6 weeks) following gynecological surgery. Pain management was at the discretion of clinical practitioners.

Main outcomes and measures

The response variable used in model development was number of pills used postoperatively, and the primary outcome was model performance using ordinal concordance and Brier score.

Results

Data from 382 female adult participants (mean age, 56 years; range, 18-87 years) undergoing gynecological surgery (minimally invasive procedures, 158 patients [73%] in cohort 1 and 118 patients [71%] in cohort 2; open surgical procedures, 58 patients [27%] in cohort 1 and 48 patients [29%] in cohort 2) were included in model development. One hundred forty-seven patients (38%) used 0 pills after hospital discharge, and the mean (SD) number of pills used was 7 (10) (median [IQR], 3 [0-10] pills). The model used 7 predictors: age, educational attainment, smoking history, anticipated pain medication use, anxiety regarding surgery, operative time, and preoperative pregabalin administration. The ordinal concordance was 0.65 (95% CI, 0.62-0.68) for predicting 5 or more pills (Brier score, 0.22), 0.65 (95% CI, 0.62-0.68) for predicting 10 or more pills (Brier score, 0.18), and 0.65 (95% CI, 0.62-0.68) for predicting 15 or more pills (Brier score, 0.14).

Conclusions and relevance

This model provides individualized estimates of outpatient opioid use following a range of gynecological surgical procedures for benign and malignant indications with all model inputs available at the time of procedure closing. Implementation of this model into the clinical setting is currently ongoing, with plans for additional validation in other surgical populations.
dc.identifier

2794443

dc.identifier.issn

2574-3805

dc.identifier.issn

2574-3805

dc.identifier.uri

https://hdl.handle.net/10161/27477

dc.language

eng

dc.publisher

American Medical Association (AMA)

dc.relation.ispartof

JAMA network open

dc.relation.isversionof

10.1001/jamanetworkopen.2022.22973

dc.subject

Humans

dc.subject

Pain, Postoperative

dc.subject

Analgesics, Opioid

dc.subject

Gynecologic Surgical Procedures

dc.subject

Models, Statistical

dc.subject

Adolescent

dc.subject

Adult

dc.subject

Aged

dc.subject

Aged, 80 and over

dc.subject

Middle Aged

dc.subject

Female

dc.subject

Drug Prescriptions

dc.subject

Young Adult

dc.subject

Pain Management

dc.subject

Practice Patterns, Physicians'

dc.title

Development and Validation of a Model for Opioid Prescribing Following Gynecological Surgery.

dc.type

Journal article

duke.contributor.orcid

Habib, Ashraf S|0000-0002-6980-1856

duke.contributor.orcid

Jelovsek, J Eric|0000-0002-7196-817X

pubs.begin-page

e2222973

pubs.issue

7

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Basic Science Departments

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Institutes and Centers

pubs.organisational-group

Anesthesiology

pubs.organisational-group

Anesthesiology, Women's

pubs.organisational-group

Obstetrics and Gynecology

pubs.organisational-group

Obstetrics and Gynecology, Gynecologic Oncology

pubs.organisational-group

Obstetrics and Gynecology, Urogynecology

pubs.organisational-group

Duke Cancer Institute

pubs.organisational-group

Population Health Sciences

pubs.publication-status

Published

pubs.volume

5

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
rodriguez_2022_oi_220646_1657654163.84575.pdf
Size:
960.96 KB
Format:
Adobe Portable Document Format
Description:
Published version