General Surgery

NPOU occurs in roughly 7% of opioid‑naïve US surgical patients.

This meta‑analysis pooled 43 observational studies (n=6,507,173) and estimated a pooled NPOU incidence of 7.15% (95% CI 6.02–8.38). Heterogeneity was very high (I2=100%) with a 95% prediction interval of 1.34%–17.02%, reflecting inconsistent definitions and follow‑up windows. Estimates varied by definition: studies using a 90–180 day window reported higher incidence than those requiring opioid use across 180 days. No consistent differences were found by surgery type, payer, age, sex, or race in metaregression analyses. 1

5x‑multiplier discharge algorithm cut median discharge OME from 75 mg to 25 mg.

In a pragmatic RCT of 150 adults after open intra‑abdominal cancer surgery, median discharge OME was 25 mg with the 5x‑multiplier versus 75 mg with a 3‑tier model (P<0.001). Fourteen‑day median opioid consumption was similar (0 mg vs 10 mg, P=0.496), and patient satisfaction and symptom scores did not differ. Forty‑four percent of patients in the 5x arm were discharged opioid‑free versus 1% in the 3‑tier arm. Refill rates were numerically similar (24% vs 18%, P=0.426), suggesting reduced initial prescribing did not clearly increase short‑term refill needs. 2

Machine learning models outperform traditional cardiac risk scores but lack external validation.

This Bayesian network meta‑analysis included 13 studies, 54 models, and 927,113 patients, finding ML approaches generally outperformed the Revised Cardiac Risk Index. Automated ML (SUCRA 96.6) and gradient boosting showed the largest discrimination gains versus traditional scores. Few studies performed external validation and calibration reporting was inconsistent, limiting immediate clinical adoption. Authors recommend prospective multicentre evaluation before routine perioperative implementation. 3