What type of study is this?

This is a Validation Study study.

What question did this study set out to answer?

To expand and validate an opioid use prediction calculator in a broader gynecologic population post-surgery.

May 6, 2026

Predicting Gynecologic Postoperative Opioid Use: Expansion and Validation of an Opioid Use Predictive Calculator ID 3711

Key Points

To expand and validate an opioid use prediction calculator in a broader gynecologic population post-surgery.
Included patients aged 18 or older undergoing major gynecologic surgery within an academic health system.
Patients completed preoperative and postoperative surveys assessing various pain and anxiety predictors.
Evaluated original and adjusted models for opioid pill usage based on patient data.
Out of 616 patients, 37% used zero pills post-discharge, median usage was 2 pills.
The original model showed a concordance index of 0.70 for predicting 2 or more pills used.
The adjusted model maintained performance across different predictions of pill usage.

Abstract

INTRODUCTION: Although most are aware that overprescription contributes to the opioid use epidemic, surgeons continue to overprescribe postoperatively. The objective was to expand an opioid prediction calculator validated in a gynecologic oncology population to a diverse gynecologic population. METHODS: Patients aged 18 years or older who underwent major gynecologic surgery within an academic health system from November 1, 2023, to November 1, 2024, were eligible for inclusion. Patients completed preoperative and postoperative surveys. The original model used seven predictors: age, educational attainment, smoking history, anticipated pain medication use, anxiety regarding surgery, operative time, and pregabalin administration. Model adjustments were evaluated: anticipated instead of actual operating time, pregabalin removal. Outcome variable for model evaluation was number of pills used. Primary outcome was model performance. RESULTS: Data from 616 patients who underwent gynecologic surgery were included: 137 gynecology (22.2%), 154 gynecologic oncology (25.0%), 163 minimally invasive gynecologic surgery (26.4%), 163 urogynecology (26.4%). 226 patients (37%) used zero pills after discharge, and the median number of pills used was 2 (interquartile range, 0, 8). Ordinal concordance index (95% CI) of the original model in the new cohort was 0.70 (0.65–0.74) for predicting 2 or more pills, 0.72 (0.68–0.76) for 5 or more pills, and 0.74 (0.7–0.79) for 10 or more pills. Ordinal concordance index of the adjusted preoperative model was 0.66 (0.64–0.69) for predicting 2 or more pills, 0.66 (0.64–0.69) for 5 or more pills, and 0.66 (0.64–0.69) for 10 or more pills. CONCLUSIONS/IMPLICATIONS: The original model performance maintained accuracy and generalized to a population of patients following a greater diversity of gynecologic specialists and subspecialty surgeries. The modified preoperative model also demonstrated sufficient performance. Widespread implementation of this calculator may decrease unused opioids in the community.

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