TABLE 3.
Study and model characteristics.
| Study | Country | Surgical population | Baseline opioid status | N/events | Outcome window | Prediction timing | Primary model | Validation level | AUROC (95% CI) | Cal/DCA | PROBAST |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Anderson AB 2020 | US | ACL reconstruction | Mixed/prior use included | 10,919/NR | Prolonged use: any opioid Rx > 90 days after ACL reconstruction (90–365 days follow-up) | Preoperative only | Gradient boosting machine | Internal split/holdout validation | 0.770 (0.750–0.800) | Yes/Yes | Low |
| Bateman BT 2016 | US | Cesarean delivery | Opioid-naive | 80,127/285 | Persistent use: trajectory-defined monthly opioid filling during 12 months after cesarean delivery | Intraop/discharge/in-hospital | Multivariable logistic regression/trajectory-based persistent-use prediction model | Resampling/internal validation | 0.670 (0.635–0.704) | No/No | High |
| Castle 2023 | US | Meniscal surgery | Mixed/prior use included | 581/98 | Prolonged use: opioid refill ≥ 1 month after arthroscopic meniscus surgery | Intraop/discharge/in-hospital | Naive Bayes model | Development only/unclear | 0.790 (0.670–0.875) | Yes/No | High |
| Chaudhary MA 2019 | US | Mixed surgery | Mixed/prior use included | 86,356/6,365 | Chronic postoperative opioid use: uninterrupted opioid Rx for ≥ 6 months post-op | Intraop/discharge/in-hospital | Stopping opioids after surgery (SOS) score | Internal split/holdout validation | 0.760 (0.746–0.774) | Yes/No | High |
| Chen 2025 | Taiwan | ACDF | Mixed/prior use included | 1,037/34 | Sustained Rx: continuous opioid use ≥ 90 days after ACDF | Preoperative only | SORG-MLA | External validation | 0.780 (0.700–0.870) | Yes/Yes | Low |
| Chen SF 2023 | Taiwan | Lumbar spine surgery | Opioid-naive | 2,795/146 | Prolonged opioid prescription: continuous opioid Rx 90–180 days after lumbar spine surgery | Preoperative only | SORG-MLA | External validation | 0.710 (0.660–0.750) | Yes/Yes | Low |
| Crawford AM 2023 | US | Mixed surgery | Mixed/prior use included | 26,114/1,039 | Sustained opioid prescriptions: continuous opioid use ≥ 90 days post-op | Intraop/discharge/in-hospital | Stopping opioids after surgery (SOS) score | External validation | 0.820 (0.804–0.835) | No/No | Unclear |
| Ekman E 2026 | Finland | Pelvic fracture surgery | Mixed/prior use included | 233/94 | Prolonged use: ≥ 1 opioid Rx after post-op month 3 (assessed at 3–12 months) | Preoperative only | Multivariable logistic regression model | Development only/unclear | 0.690 (0.615–0.756) | Yes/No | Unclear |
| Gabriel 2022 | US | LE arthroplasty | Mixed/prior use included | 1,042/242 | Persistent use: continued opioid use 3–6 months after arthroplasty | Intraop/discharge/in-hospital | Balanced bagging classifier | Resampling/internal validation | 0.959 (0.896–0.985) | No/No | High |
| Gessner KH 2025 | US | Mixed surgery | Opioid-naive | 4,116/245 | New persistent use: ≥ 1 opioid Rx 90–180 days after surgery in opioid-naive patients | Preoperative only | Model E + C + G logistic regression | Resampling/internal validation | 0.667 (0.619–0.717) | Yes/No | Unclear |
| Giladi 2023 | US | Hand/UE surgery | Mixed/prior use included | 1,656/142 | Persistent use: continued opioid use at 6 months after surgery | Preoperative only | XGBoost model | Resampling/internal validation | 0.730 (0.660–0.790) | Yes/No | Unclear |
| Grazal 2022 | US | Arthroscopic hip surgery | Mixed/prior use included | 6,760/2,762 | Prolonged postoperative opioid use: opioid fill between 90 and 365 days after hip arthroscopy | Postoperative-updated | Artificial neural network model | Development only/unclear | 0.710 (0.680–0.740) | Yes/Yes | Unclear |
| Guattery J 2025 | US | Rotator cuff repair | Mixed/prior use included | 852/172 | Prolonged postoperative opioid use: opioid prescription fill ≥ 90 days after rotator cuff surgery | Intraop/discharge/in-hospital | XGBoost model | Resampling/internal validation | 0.990 (0.972–0.997) | No/No | High |
| Harris 2020 | US | ACDF | Mixed/prior use included | 28,813/4,986 | Chronic postoperative opioid use: ≥ 120 days supply or ≥ 10 opioid prescriptions between months 3 and 12 | Preoperative only | Final multivariable logistic regression model | Development only/unclear | 0.770 (0.762–0.778) | No/No | High |
| Hur 2021 | US | Other surgery | Opioid-naive | 112,989/6,531 | New persistent use: opioid fill 91–180 days after surgery in opioid-naive patients | Preoperative only | XGBoost model for new persistent use | Internal split/holdout validation | 0.660 (0.640–0.680) | No/No | High |
| Karhade 2019 | US | Mixed surgery | Mixed/prior use included | 7,027/604 | Sustained prescription opioid use: opioid prescription without interruption through 90–180 days post-op | Intraop/discharge/in-hospital | Stopping opioids after surgery (SOS) score | External validation | 0.764 (0.741–0.786) | No/No | Unclear |
| Karhade AV 2020 | US | Lumbar spine surgery | Mixed/prior use included | 4,165/61 | Sustained postoperative prescription opioid exposure at 6 months after lumbar surgery | Intraop/discharge/in-hospital | Stopping opioids after surgery (SOS) score | External validation | 0.820 (0.740–0.870) | No/No | Unclear |
| Kim J 2025 | South Korea | Mixed surgery | Mixed/prior use included | 1108119/9,308 | Chronic opioid use: ≥ 10 prescriptions or >120 days supply between 91 and 365 days after discharge | Intraop/discharge/in-hospital | Gradient boosting machine | Development only/unclear | 0.875 (0.871–0.879) | No/No | Unclear |
| Kunze 2021 | US | Hip arthroscopy | Opioid-naive | 775/227 | Prolonged use: any opioid use beyond 1 month after hip arthroscopy in opioid-naive patients | Preoperative only | Stochastic gradient boosting | Internal split/holdout validation | 0.750 (0.630–0.830) | Yes/Yes | Unclear |
| Lu Y 2022 | US | Knee arthroscopy | Mixed/prior use included | 381/60 | Long-term opioid use: filling ≥ 180-day supply of opioids within 1 year after surgery | Postoperative-updated | Complete ensemble model | Resampling/internal validation | 0.740 (0.658–0.808) | Yes/Yes | Unclear |
| Naderalvojoud 2025 | US | Other surgery | Mixed/prior use included | 397,150/136,222 | Prolonged use: opioid exposure between 90 and 180 days after surgery (model validation/fairness analysis) | Preoperative only | Lasso logistic regression | External validation | 0.700 (0.698–0.702) | Yes/Yes | Unclear |
| Naderalvojoud 2023 | US | Other surgery | Mixed/prior use included | 41,675/6,071 | Prolonged use: any opioid exposure 90–180 days after surgery | Preoperative only | Ensemble lasso logistic regression | Resampling/internal validation | 0.784 (0.769–0.800) | Yes/No | Unclear |
| Nicholson AD 2019 | US | Shoulder surgery | Mixed/prior use included | 548/153 | Prolonged use: opioid use >6 weeks after shoulder surgery | Preoperative only | Restricted logistic regression model | Resampling/internal validation | 0.766 (0.736–0.820) | Yes/No | Unclear |
| Shipp MM 2022 | US | Hand/UE surgery | Mixed/prior use included | 2,114/212 | Prolonged use: opioid refill/use at 3 months after upper extremity surgery | Preoperative only | Main lasso/multivariable model using EHR and PRD | External validation | 0.603 (0.513–0.686) | Yes/No | Unclear |
| Simpson S 2024 | US | Major spine surgery | Mixed/prior use included | 2,611/1,209 | Persistent use: opioid use at 3 months after major spine surgery | Preoperative only | Balanced random forest classifier with SMOTE | Internal split/holdout validation | 0.877 (0.834–0.894) | Yes/No | Unclear |
| Singh K 2022 | US | Mixed surgery | Mixed/prior use included | 24,040/4,879 | Persistent use: filling opioids in days 4–90 and 91–180 after surgery | Preoperative only | Full prediction model | Internal split/holdout validation | 0.870 (0.860–0.880) | Yes/Yes | Unclear |
| Soley 2024 | US | Other surgery | Mixed/prior use included | 347/42 | Chronic opioid use: ≥ 1 opioid prescription filled between 6 and 12 months after surgery | Preoperative only | Stacking ensemble model | Development only/unclear | 0.900 (0.880–0.920) | No/No | Unclear |
| Soley 2025 | US | Other surgery | Mixed/prior use included | 271/32 | Chronic opioid use: ≥ 1 opioid prescription filled between 6 and 12 months after surgery | Preoperative only | Stacking ensemble model with genetic, EHR, and wearable data | Internal split/holdout validation | 0.950 (0.890–0.950) | No/No | Unclear |
| Sun M 2024 | Taiwan | Major elective surgery under general anesthesia | Mixed/prior use included | 111,069/1812 | Chronic opioid use: opioid use >90 days after surgery | Intraop/discharge/in-hospital | Wu and Zhang predictive scoring system | Resampling/internal validation | 0.830 (0.818–0.841) | No/No | High |
| Tsai CC 2023 | Taiwan | Total knee arthroplasty | Mixed/prior use included | 3,495/114 | Prolonged postoperative opioid prescription: continuous opioid use after TKA (original SORG definition) | Preoperative only | SORG-MLA | External validation | 0.750 (0.700–0.810) | Yes/Yes | Low |
| Tudorache Ym 2026 | Denmark | Hip fracture surgery | Opioid-naive | 26,057/8,095 | Long-term opioid therapy: Redeeming ≥ 2 opioid prescriptions between 31 and 365 days after hip fracture surgery | Intraop/discharge/in-hospital | Backward-elimination logistic regression model | Internal split/holdout validation | 0.680 (0.660–0.690) | Yes/Yes | Low |
| Ward A 2021 | US | Mixed adolescent surgery | Mixed/prior use included | 186,493/8,410 | Prolonged opioid use after surgery: opioid use during postoperative follow-up | Postoperative-updated | Day-of-surgery gradient boosting machine | Internal split/holdout validation | 0.711 (0.699–0.723) | No/No | High |
| Yeh Ph 2026 | Taiwan | TKA | Mixed/prior use included | 12,958/1,029 | Long-term opioid use: repeated opioid prescriptions ≥ 2 times between 90 and 360 days after TKA | Postoperative-updated | LASSO-elastic net penalized logistic regression | Development only/unclear | 0.821 (0.808–0.835) | Yes/No | Unclear |
| Yen 2022 | Taiwan | Lumbar disc surgery | Mixed/prior use included | 1,316/41 | Prolonged postoperative opioid prescription: continuous opioid use to at least 90–180 days after lumbar disc herniatio | Preoperative only | SORG-MLA | External validation | 0.760 (0.690–0.830) | Yes/Yes | Low |
| Zhang Y 2020 | US | Lumbar spine surgery | Opioid-naive | 19,317/903 | Long-term opioid use: filling ≥ 180-day supply of opioids within 1 year after surgery | Postoperative-updated | Full logistic regression model | Development only/unclear | 0.847 (0.808–0.879) | Yes/No | Unclear |
Abbreviations: ACL, anterior cruciate ligament; ACDF, anterior cervical discectomy and fusion; AUROC, area under the receiver operating characteristic curve; Cal, calibration; CI, confidence interval; DCA, decision curve analysis; d, days; E + C + G, electronic health record plus claims and geographic factors; EHR, electronic health record; LE, lower extremity; LASSO, least absolute shrinkage and selection operator; ML, machine learning; MME, morphine milligram equivalents; mo, months; NR, not reported; post-op, postoperative; PRD, patient-reported data; PRO, patient-reported outcome; PROBAST, Prediction model Risk Of Bias Assessment Tool; Rx, prescription; SMOTE, synthetic minority oversampling technique; SOS, Stopping Opioids after Surgery; SORG-MLA, Skeletal Oncology Research Group machine-learning algorithm; TKA, total knee arthroplasty; UE, upper extremity; US, United States; wk, weeks; XGBoost, extreme gradient boosting; y, years. N/events denotes the total sample size and number of outcome events, respectively.