Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Performance Evaluation of Soft Computing for Modeling the Strength Properties of Waste Substitute Green Concrete

The waste disposal crisis and development of various types of concrete simulated by the construction industry has encouraged further research to safely utilize the wastes and develop accurate predictive models for estimation of concrete properties. In the present study, sugarcane bagasse ash (SCBA), a by-product from the agricultural industry, was processed and used in the production of green concrete. An advanced variant of machine learning, i.e., multi expression programming (MEP), was then used to develop predictive models for modeling the mechanical properties of SCBA substitute concrete. The most significant parameters, i.e., water-to-cement ratio, SCBA replacement percentage, amount of cement, and quantity of coarse and fine aggregate, were used as modeling inputs. The MEP models were developed and trained by the data acquired from the literature; furthermore, the modeling outcome was validated through laboratory obtained results. The accuracy of the models was then assessed by statistical criteria. The results revealed a good approximation capacity of the trained MEP models with correlation coefficient above 0.9 and root means squared error (RMSE) value below 3.5 MPa. The results of cross-validation confirmed a generalized outcome and the resolved modeling overfitting. The parametric study has reflected the effect of inputs in the modeling process. Hence, the MEP-based modeling followed by validation with laboratory results, cross-validation, and parametric study could be an effective approach for accurate modeling of the concrete properties.publishedVersio

Performance Evaluation of Soft Computing for Modeling the Strength Properties of Waste Substitute Green Concrete

The waste disposal crisis and development of various types of concrete simulated by the construction industry has encouraged further research to safely utilize the wastes and develop accurate predictive models for estimation of concrete properties. In the present study, sugarcane bagasse ash (SCBA), a by-product from the agricultural industry, was processed and used in the production of green concrete. An advanced variant of machine learning, i.e., multi expression programming (MEP), was then used to develop predictive models for modeling the mechanical properties of SCBA substitute concrete. The most significant parameters, i.e., water-to-cement ratio, SCBA replacement percentage, amount of cement, and quantity of coarse and fine aggregate, were used as modeling inputs. The MEP models were developed and trained by the data acquired from the literature; furthermore, the modeling outcome was validated through laboratory obtained results. The accuracy of the models was then assessed by statistical criteria. The results revealed a good approximation capacity of the trained MEP models with correlation coefficient above 0.9 and root means squared error (RMSE) value below 3.5 MPa. The results of cross-validation confirmed a generalized outcome and the resolved modeling overfitting. The parametric study has reflected the effect of inputs in the modeling process. Hence, the MEP-based modeling followed by validation with laboratory results, cross-validation, and parametric study could be an effective approach for accurate modeling of the concrete properties

Machine Learning-Based Modeling with Optimization Algorithm for Predicting Mechanical Properties of Sustainable Concrete

In this research, multiexpression programming (MEP) has been employed to model the compressive strength, splitting tensile strength, and flexural strength of waste sugarcane bagasse ash (SCBA) concrete. Particle swarm optimization (PSO) algorithm was used to fine-tune the hyperparameter of the proposed MEP. The formulation of SCBA concrete was correlated with five input parameters. To train and test the proposed model, a large number of data were collected from the published literature. Afterward, waste SCBA was collected, processed, and characterized for partial replacement of cement in concrete. Concrete specimens with varying proportion of SCBA were prepared in the laboratory, and results were used for model validation. The performance of the developed models was then evaluated by statistical criteria and error assessment tests. The result shows that the performance of MEP with PSO algorithm significantly enhanced its accuracy. The essential input variables affecting the output were revealed, and the parametric analysis confirms that the models are accurate and have captured the essential properties of SCBA. Finally, the cross validation ensured the generalized capacity and robustness of the models. Hence, the adopted approach, i.e., MEP-based modeling with PSO, could be an effective tool for accurate modeling of the concrete properties, thus directly contributing to the construction sector by consuming waste and protecting the environment