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Predicting inadequate postoperative pain management in depressed patients: A machine learning approach.

ABSTRACT: Widely-prescribed prodrug opioids (e.g., hydrocodone) require conversion by liver enzyme CYP-2D6 to exert their analgesic effects. The most commonly prescribed antidepressant, selective serotonin reuptake inhibitors (SSRIs), inhibits CYP-2D6 activity and therefore may reduce the effectiveness of prodrug opioids. We used a machine learning approach to identify patients prescribed a combination of SSRIs and prodrug opioids postoperatively and to examine the effect of this combination on postoperative pain control. Using EHR data from an academic medical center, we identified patients receiving surgery over a 9-year period. We developed and validated natural language processing (NLP) algorithms to extract depression-related information (diagnosis, SSRI use, symptoms) from structured and unstructured data elements. The primary outcome was the difference between preoperative pain score and postoperative pain at discharge, 3-week and 8-week time points. We developed computational models to predict the increase or decrease in the postoperative pain across the 3 time points by using the patient's EHR data (e.g. medications, vitals, demographics) captured before surgery. We evaluate the generalizability of the model using 10-fold cross-validation method where the holdout test method is repeated 10 times and mean area-under-the-curve (AUC) is considered as evaluation metrics for the prediction performance. We identified 4,306 surgical patients with symptoms of depression. A total of 14.1% were prescribed both an SSRI and a prodrug opioid, 29.4% were prescribed an SSRI and a non-prodrug opioid, 18.6% were prescribed a prodrug opioid but were not on SSRIs, and 37.5% were prescribed a non-prodrug opioid but were not on SSRIs. Our NLP algorithm identified depression with a F1 score of 0.95 against manual annotation of 300 randomly sampled clinical notes. On average, patients receiving prodrug opioids had lower average pain scores (p<0.05), with the exception of the SSRI+ group at 3-weeks postoperative follow-up. However, SSRI+/Prodrug+ had significantly worse pain control at discharge, 3 and 8-week follow-up (p < .01) compared to SSRI+/Prodrug- patients, whereas there was no difference in pain control among the SSRI- patients by prodrug opioid (p>0.05). The machine learning algorithm accurately predicted the increase or decrease of the discharge, 3-week and 8-week follow-up pain scores when compared to the pre-operative pain score using 10-fold cross validation (mean area under the receiver operating characteristic curve 0.87, 0.81, and 0.69, respectively). Preoperative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. We provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. Current prescribing patterns indicate that prescribers may not account for this interaction when choosing an opioid. The study results imply that prescribers might instead choose direct acting opioids (e.g. oxycodone or morphine) in depressed patients on SSRIs.

SUBMITTER: Parthipan A

PROVIDER: S-EPMC6364959 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Purpose Predictive analytics (PA) is a new trending approach in the field of healthcare that uses machine learning to build a prediction model using supervised learning algorithms. Isolated coronary artery bypass grafting (iCABG), an open-heart surgery, is commonly performed in the treatment of coronary heart disease. Aim The aim of this study was to develop and evaluate a model to predict postoperative length of stay (PLoS) for iCABG patients using supervised machine learning techniques, and to identify the features with the highest contribution to the model. Methods This is a retrospective study that uses historic data of adult patients who underwent isolated CABG (iCABG). After initial data pre-processing, data imputation using the kNN method was applied. The study used five prediction models using Naïve Bayes, Decision Tree, Random Forest, Logistic Regression and k Nearest Neighbor algorithms. Data imbalance was managed using the following widely used methods: oversampling, undersampling, “Both”, and random over-sampling examples (ROSE). The features selection process was conducted using the Boruta method. Two techniques were applied to examine the performance of the models, (70%, 30%) split and cross-validation, respectively. Models were evaluated by comparing their performance using AUC and other metrics. Results In the final dataset, six distinct features and 621 instances were used to develop the models. A total of 20 models were developed using R statistical software. The model generated using Random Forest with “Both” resampling method and cross-validation technique was deemed the best fit (AUC=0.81; F1 score=0.82; and recall=0.82). Attributes found to be highly predictive of PLoS were pulmonary artery systolic, age, height, EuroScore II, intra-aortic balloon pump used, and complications during operation. Conclusion This study demonstrates the significance and effectiveness of building a model that predicts PLoS for iCABG patients using patient specifications and pre-/intra-operative measures.

Project description:Interpersonal violence (IPV) is highly prevalent in the United States and is a major public health problem. The emergence and/or worsening of chronic pain are known sequelae of IPV; however, not all those who experience IPV develop chronic pain. To mitigate its development, it is critical to identify the factors that are associated with increased risk of pain after IPV. This proof-of-concept study used machine-learning strategies to predict pain severity and interference in 47 young women, ages 18 to 30, who experienced an incident of IPV (i.e., physical and/or sexual assault) within three months of their baseline assessment. Young women are more likely than men to experience IPV and to subsequently develop posttraumatic stress disorder (PTSD) and chronic pain. Women completed a comprehensive assessment of theory-driven cognitive and neurobiological predictors of pain severity and pain-related interference (e.g., pain, coping, disability, psychiatric diagnosis/symptoms, PTSD/trauma, executive function, neuroendocrine, and physiological stress response). Gradient boosting machine models were used to predict symptoms of pain severity and pain-related interference across time (Baseline, 1-,3-,6- follow-up assessments). Models showed excellent predictive performance for pain severity and adequate predictive performance for pain-related interference. This proof-of-concept study suggests that machine-learning approaches are a useful tool for identifying predictors of pain development in survivors of recent IPV. Baseline measures of pain, family life impairment, neuropsychological function, and trauma history were of greatest importance in predicting pain and pain-related interference across a 6-month follow-up period. Present findings support the use of machine-learning techniques in larger studies of post-IPV pain development and highlight theory-driven predictors that could inform the development of targeted early intervention programs. However, these results should be replicated in a larger dataset with lower levels of missing data.

Project description:BackgroundThe Centers for Medicare and Medicaid Services projects that health care costs will continue to grow over the next few years. Rising readmission costs contribute significantly to increasing health care costs. Multiple areas of health care, including readmissions, have benefited from the application of various machine learning algorithms in several ways.ObjectiveWe aimed to identify suitable models for predicting readmission charges billed by hospitals. Our literature review revealed that this application of machine learning is underexplored. We used various predictive methods, ranging from glass-box models (such as regularization techniques) to black-box models (such as deep learning-based models).MethodsWe defined readmissions as readmission with the same major diagnostic category (RSDC) and all-cause readmission category (RADC). For these readmission categories, 576,701 and 1,091,580 individuals, respectively, were identified from the Nationwide Readmission Database of the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality for 2013. Linear regression, lasso regression, elastic net, ridge regression, eXtreme gradient boosting (XGBoost), and a deep learning model based on multilayer perceptron (MLP) were the 6 machine learning algorithms we tested for RSDC and RADC through 10-fold cross-validation.ResultsOur preliminary analysis using a data-driven approach revealed that within RADC, the subsequent readmission charge billed per patient was higher than the previous charge for 541,090 individuals, and this number was 319,233 for RSDC. The top 3 major diagnostic categories (MDCs) for such instances were the same for RADC and RSDC. The average readmission charge billed was higher than the previous charge for 21 of the MDCs in the case of RSDC, whereas it was only for 13 of the MDCs in RADC. We recommend XGBoost and the deep learning model based on MLP for predicting readmission charges. The following performance metrics were obtained for XGBoost: (1) RADC (mean absolute percentage error [MAPE]=3.121%; root mean squared error [RMSE]=0.414; mean absolute error [MAE]=0.317; root relative squared error [RRSE]=0.410; relative absolute error [RAE]=0.399; normalized RMSE [NRMSE]=0.040; mean absolute deviation [MAD]=0.031) and (2) RSDC (MAPE=3.171%; RMSE=0.421; MAE=0.321; RRSE=0.407; RAE=0.393; NRMSE=0.041; MAD=0.031). The performance obtained for MLP-based deep neural networks are as follows: (1) RADC (MAPE=3.103%; RMSE=0.413; MAE=0.316; RRSE=0.410; RAE=0.397; NRMSE=0.040; MAD=0.031) and (2) RSDC (MAPE=3.202%; RMSE=0.427; MAE=0.326; RRSE=0.413; RAE=0.399; NRMSE=0.041; MAD=0.032). Repeated measures ANOVA revealed that the mean RMSE differed significantly across models with P<.001. Post hoc tests using the Bonferroni correction method indicated that the mean RMSE of the deep learning/XGBoost models was statistically significantly (P<.001) lower than that of all other models, namely linear regression/elastic net/lasso/ridge regression.ConclusionsModels built using XGBoost and MLP are suitable for predicting readmission charges billed by hospitals. The MDCs allow models to accurately predict hospital readmission charges.

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Predicting inadequate postoperative pain management in depressed patients: A machine learning approach.

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