Key result
POPS machine learning model outperforms clinicians in predicting maximum postoperative pain using preoperative EHR data.
Why the study?
Current methods for predicting postoperative pain require patient and clinician input or laborious manual chart review and often lack sufficient performance.
Does the POPS machine learning model improve the prediction of postoperative pain compared to clinician predictions in adult non-cardiac surgical patients?
Cohort (n=234,639)
Yes
Does the POPS machine learning model improve the prediction of postoperative pain compared to clinician predictions in adult non-cardiac surgical patients?
An automated machine learning model using preoperative EHR data can predict postoperative pain trajectories more accurately than clinicians, potentially guiding personalized perioperative pain management.
POPS may enable automated preoperative risk stratification; leaves open whether integration improves pain outcomes or practice.
Preoperative knowledge of expected postoperative pain can help guide perioperative pain management and focus interventions on patients with the greatest risk of acute pain. However, current methods for predicting postoperative pain require patient and clinician input or laborious manual chart review and often do not achieve sufficient performance. We use routinely collected electronic health record data from a multicenter dataset of 234,274 adult non-cardiac surgical patients to develop a machine learning method which predicts maximum pain scores on the day of surgery and four subsequent days and validate this method in a prospective cohort. Our method, POPS, is fully automated and relies only on data available prior to surgery, allowing application in all patients scheduled for or considering surgery. Here we report that POPS achieves state-of-the-art performance and outperforms clinician predictions on all postoperative days when predicting maximum pain on the 0-10 NRS in prospective validation, though with degraded calibration. POPS is interpretable, identifying comorbidities that significantly contribute to postoperative pain based on patient-specific context, which can assist clinicians in mitigating cases of acute pain.
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Liu et al. (2023) conducted a cohort in Postoperative pain (n=234,639). POPS (Personalized post-Operative Pain prediction Score) vs. Clinician predictions was evaluated on Maximum pain score on the day of surgery and four subsequent days (AUC 0.67-0.76 for moderate pain). The POPS machine learning model predicted maximum postoperative pain scores using preoperative EHR data, outperforming clinician predictions on all postoperative days in a prospective validation cohort.
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