Clinical characteristics stratified by SSRI use and prodrug prescription, 2009–2017.

Clinical characteristics stratified by SSRI use and prodrug prescription, 2009–2017.</p

Identification of depressed patients and patients on SSRIs using clinical notes and structured data.

Identification of depressed patients and patients on SSRIs using clinical notes and structured data.</p

Discriminative features selected by the three models: Coefficients computed by the ElasticNet models are represented as weights.

(A) discharge postoperative pain score predictions. (B) 3-week postoperative pain score predictions. (C) 8-week postoperative pain score predictions.</p

Mean change in pain score, stratified by SSRI medication and opioid prodrug prescription^*.

Mean change in pain score, stratified by SSRI medication and opioid prodrug prescription*.</p

Receiver operator characteristic (ROC) curves for the model’s performance with 10-fold cross validation at three postoperative time-points.

(A) ROC-AUC for prediction of pain score change at discharge. (B) ROC-AUC for prediction of pain score change at 3 weeks. (C) ROC-AUC for prediction of pain score change at 8 weeks.</p

Baseline patient characteristics stratified by SSRI and prodrug opioid prescription, 2009–2017.

Baseline patient characteristics stratified by SSRI and prodrug opioid prescription, 2009–2017.</p

Comparison of the performance of the models using area under the curve (AUC) of ROC.

Comparison of the performance of the models using area under the curve (AUC) of ROC.</p

Sample sentences and the corresponding annotations for depression symptoms.

Sample sentences and the corresponding annotations for depression symptoms.</p

Flowchart of study cohort, 2008–2020.

BackgroundOpioids are commonly prescribed for postoperative pain, but may lead to prolonged use and addiction. Diabetes impairs nerve function, complicates pain management, and makes opioid prescribing particularly challenging.MethodsThis retrospective observational study included a cohort of postoperative patients from a multisite academic health system to assess the relationship between diabetes, pain, and prolonged opioid use (POU), 2008–2019. POU was defined as a new opioid prescription 3–6 months after discharge. The odds that a patient had POU was assessed using multivariate logistic regression controlling for patient factors (e.g., demographic and clinical factors, as well as prior pain and opiate use).FindingsA total of 43,654 patients were included, 12.4% with diabetes. Patients with diabetes had higher preoperative pain scores (2.1 vs 1.9, pInterpretationIn conclusion, surgical patients with diabetes are at increased risk for POU even after controlling for likely covariates, yet they receive similar postoperative opiate therapy. The results suggest a more tailored approach to diabetic postoperative pain management is warranted.</div

Study patient characteristics stratified by diabetes diagnosis.

Study patient characteristics stratified by diabetes diagnosis.</p