Aditya V Karhade1, Paul T Ogink1, Quirina C B S Thio1, Thomas D Cha1, William B Gormley2, Stuart H Hershman1, Timothy R Smith2, Jianren Mao3, Andrew J Schoenfeld4, Christopher M Bono1, Joseph H Schwab5. 1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 2. Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 3. Divison of Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 4. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 5. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: jhschwab@mgh.harvard.edu.
Abstract
BACKGROUND CONTEXT: Spine surgery has been identified as a risk factor for prolonged postoperative opioid use. Preoperative prediction of opioid use could improve risk stratification, shared decision-making, and patient counseling before surgery. PURPOSE: The primary purpose of this study was to develop algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation. STUDY DESIGN/ SETTING: Retrospective, case-control study at five medical centers. PATIENT SAMPLE: Chart review was conducted for patients undergoing surgery for lumbar disc herniation between January 1, 2000 and March 1, 2018. OUTCOME MEASURES: The primary outcome of interest was sustained opioid prescription after surgery to at least 90 to 180 days postoperatively. METHODS: Five models (elastic-net penalized logistic regression, random forest, stochastic gradient boosting, neural network, and support vector machine) were developed to predict prolonged opioid prescription. Explanations of predictions were provided globally (averaged across all patients) and locally (for individual patients). RESULTS: Overall, 5,413 patients were identified, with sustained postoperative opioid prescription of 416 (7.7%) at 90 to 180 days after surgery. The elastic-net penalized logistic regression model had the best discrimination (c-statistic 0.81) and good calibration and overall performance; the three most important predictors were: instrumentation, duration of preoperative opioid prescription, and comorbidity of depression. The final models were incorporated into an open access web application able to provide predictions as well as patient-specific explanations of the results generated by the algorithms. The application can be found here: https://sorg-apps.shinyapps.io/lumbardiscopioid/ CONCLUSION: Preoperative prediction of prolonged postoperative opioid prescription can help identify candidates for increased surveillance after surgery. Patient-centered explanations of predictions can enhance both shared decision-making and quality of care.
BACKGROUND CONTEXT: Spine surgery has been identified as a risk factor for prolonged postoperative opioid use. Preoperative prediction of opioid use could improve risk stratification, shared decision-making, and patient counseling before surgery. PURPOSE: The primary purpose of this study was to develop algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation. STUDY DESIGN/ SETTING: Retrospective, case-control study at five medical centers. PATIENT SAMPLE: Chart review was conducted for patients undergoing surgery for lumbar disc herniation between January 1, 2000 and March 1, 2018. OUTCOME MEASURES: The primary outcome of interest was sustained opioid prescription after surgery to at least 90 to 180 days postoperatively. METHODS: Five models (elastic-net penalized logistic regression, random forest, stochastic gradient boosting, neural network, and support vector machine) were developed to predict prolonged opioid prescription. Explanations of predictions were provided globally (averaged across all patients) and locally (for individual patients). RESULTS: Overall, 5,413 patients were identified, with sustained postoperative opioid prescription of 416 (7.7%) at 90 to 180 days after surgery. The elastic-net penalized logistic regression model had the best discrimination (c-statistic 0.81) and good calibration and overall performance; the three most important predictors were: instrumentation, duration of preoperative opioid prescription, and comorbidity of depression. The final models were incorporated into an open access web application able to provide predictions as well as patient-specific explanations of the results generated by the algorithms. The application can be found here: https://sorg-apps.shinyapps.io/lumbardiscopioid/ CONCLUSION: Preoperative prediction of prolonged postoperative opioid prescription can help identify candidates for increased surveillance after surgery. Patient-centered explanations of predictions can enhance both shared decision-making and quality of care.
Authors: Kevin Berardino; Austin H Carroll; Alicia Kaneb; Matthew D Civilette; William F Sherman; Alan D Kaye Journal: Orthop Rev (Pavia) Date: 2021-06-22
Authors: Olivier Q Groot; Michiel E R Bongers; Paul T Ogink; Joeky T Senders; Aditya V Karhade; Jos A M Bramer; Jorrit-Jan Verlaan; Joseph H Schwab Journal: Clin Orthop Relat Res Date: 2020-12 Impact factor: 4.755
Authors: Michiel E R Bongers; Aditya V Karhade; Elisabetta Setola; Marco Gambarotti; Olivier Q Groot; Kivilcim E Erdoğan; Piero Picci; Davide M Donati; Joseph H Schwab; Emanuela Palmerini Journal: Clin Orthop Relat Res Date: 2020-10 Impact factor: 4.755
Authors: Ashley B Anderson; Clare F Grazal; George C Balazs; Benjamin K Potter; Jonathan F Dickens; Jonathan A Forsberg Journal: Clin Orthop Relat Res Date: 2020-07 Impact factor: 4.755