Postoperative pain and pain management and neurocognitive outcomes after non-cardiac surgery: a protocol for a series of systematic reviews
Bibliographic record
Abstract
BACKGROUND: Postoperative delirium (POD) is common after non-cardiac surgery in older adults and can result in increased risk of adverse outcomes including postoperative cognitive dysfunction (POCD). Pain after surgery is also frequent and can persist as chronic postsurgical pain (CPSP). Evidence is inconsistent and controversial on whether acute and chronic postsurgical pain, and different postoperative pain management strategies (including opioid versus opioid-sparing strategies), is associated with the occurrence of POD and POCD. In this protocol, we propose a series of systematic reviews to answer the following research questions: In adults undergoing non-cardiac surgery, (1) is acute postsurgical pain associated with POD and/or POCD? (2) Are opioid-sparing/avoidance strategies of acute postoperative pain management associated with lower incidence and/or severity of POD and POCD, compared to predominantly opioid-based strategies? (3) Is CPSP associated with POCD? (4) Are opioid-sparing management strategies of CPSP associated with lower incidence and/or severity of POCD compared to standard of care or strategies not aiming at reduced opioid use? METHODS: We will search MEDLINE, EMBASE, Cochrane (CENTRAL), CINAHL, and PSYCHINFO. According to the research question, we will include cohort and case-control studies (questions 1 and 3) or randomized controlled trials and non-randomized studies (questions 2 and 4). The risk of bias will be assessed independently and in duplicate using the revised Cochrane risk-of-bias tool, the Newcastle-Ottawa Scale, and the Joanna-Briggs Institute critical appraisal checklist. Disagreements will be resolved by a third reviewer. Findings will be reported narratively, and where possible and appropriate, meta-analyses will be performed. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We will conduct the reviews in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols. DISCUSSION: Our systematic reviews will summarize available evidence to date on the association of postoperative pain and its management strategies with the incidence of POD and POCD in non-cardiac surgery. We will evaluate the existing evidence and its limitations and inform the design of future interventional studies comparing the effects of different pain management strategies on postoperative neurocognitive outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021192105.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Protocol About the Canadian research system: no · About a Canadian topic: no | Not applicable | low |
| gpt | no category Domain: not available · Genre: Protocol About the Canadian research system: no · About a Canadian topic: no | Not applicable | high |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".