Postoperative Opioid Use Prediction Calculator Performance in Patients Undergoing Gynecologic Surgery
Authors' conclusion
This prognostic study of patients who underwent major gynecologic surgery found that the original calculator showed moderate threshold-specific discrimination but overpredicted opioid use at the higher thresholds of pill use. The updated model showed moderate discrimination after internal validation, with calibration intercepts near 0 and slopes ranging from 0.93 to 1.15. External institutional validation is needed. Individualized estimates may support opioid stewardship.
Study context
- Population
- Patients aged 18 years or older who underwent gynecologic surgery in a quaternary health system, excluding those undergoing only minor procedureshad complete opioid use outcome data (of 884 identified, 870 eligible, 835 underwent surgery)
- Participants
- 616 patients
- Comparison
- Postoperative opioid use prediction calculator (original and updated models) against observed number of pills used
- Outcome
- Number of pills used
- Follow-up
- Up to 6 weeks
Methodological detailsexternal validation, prespecified updated proportional odds model, internal validation, multiple imputation (71 imputation-specific models)
- External validation
- Prespecified updated proportional odds model
- Internal validation
- Multiple imputation (71 imputation-specific models)
Performance
As reported in the abstract
Median number of pills used
2
IQR, 0–7 pills
Patients who used no pills
226 patients
36.7%
Further findings
- Original model threshold-specific C statistics (≥2, ≥5, ≥10 pills)
- 0.70 (95% CI, 0.66-0.74) · C statistic, at least 2 pills · C statistic, at least 5 pills 0.72 (95% CI, 0.68-0.76) · C statistic, at least 10 pills 0.74 (95% CI, 0.70-0.78)
- Original model calibration intercepts (≥2, ≥5, ≥10 pills)
- −0.11 (95% CI, −0.30 to 0.08) · Calibration intercept, at least 2 pills · Calibration intercept, at least 5 pills −0.35 (95% CI, −0.54 to −0.17) · Calibration intercept, at least 10 pills −0.51 (95% CI, −0.71 to −0.31)
- Updated model optimism-corrected C statistics (≥2, ≥5, ≥10 pills)
- 0.71 (95% CI, 0.66-0.74) · C statistic, at least 2 pills · C statistic, at least 5 pills 0.73 (95% CI, 0.68-0.76) · C statistic, at least 10 pills 0.73 (95% CI, 0.67-0.77)
- Updated model calibration intercepts (≥2, ≥5, ≥10 pills)
- −0.05 (95% CI, −0.09 to −0.01) · Calibration intercept, at least 2 pills · Calibration intercept, at least 5 pills −0.04 (95% CI, −0.08 to 0.002) · Calibration intercept, at least 10 pills −0.03 (95% CI, −0.07 to 0.01)
- Updated model calibration slopes (≥2, ≥5, ≥10 pills)
- 0.93 (95% CI, 0.80-1.02) · Calibration slope, at least 2 pills · Calibration slope, at least 5 pills 1.06 (95% CI, 0.89-1.19) · Calibration slope, at least 10 pills 1.15 (95% CI, 0.85-1.37)
- Original model calibration intercepts (≥2, ≥5, ≥10 pills): indicating overpredicted use at the higher thresholds of pill use
Original publication
Postoperative Opioid Use Prediction Calculator Performance in Patients Undergoing Gynecologic Surgery. JAMA Netw Open. Published 1 October 2026. doi:10.
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