Predicting opioid consumption after surgical discharge: a multinational derivation and validation study using a foundation model Chris Varghese, Luke Peters, Lorane Gaborit, William Xu, Kaviya Kalyanasundaram, et al. Npj Digital Medicine, 2025 Opioids are frequently overprescribed after surgery. We applied a tabular foundation model to predict the risk of post-discharge opioid consumption. The model was trained and internally validated on an 80:20 training/test split of the ‘Opioid PrEscRiptions and usage After Surgery’ (ACTRN12621001451897p) study cohort, including adult patients undergoing general, orthopaedic, gynaecological and urological operations (n = 4267), with external validation in a distinct cohort of patients discharged after general surgical procedures (n = 826). The area under the receiver operator curve was 0.84 (95% confidence interval [CI] 0.81–0.88) at internal testing and 0.77 (95% CI 0.74–0.80) at external validation. Brier scores were 0.13 (95% CI 0.12–0.14) and 0.19 (95% CI 0.17–0.2). Patients with a <50% predicted risk of opioid consumption consumed a median of 0 oral morphine equivalents in the first week after surgery. Applying this model would reduce opioid prescriptions by 4.5% globally, and counterfactual modelling suggests without increasing time in severe pain (−4.3%, 95% CI −17.7 to 8.6).
Patterns of Trauma Presentation in Ilorin, Nigeria: A 15-Year Review G. Ibraheem, Abdur-Rasheed Adegoke Nasir, O. M. Babalola, L. Abdur-rahman, B. Solagberu Ethiopian Journal of Health Sciences, 2025 Background Injuries make up a significant portion of the emergency surgical patient load in most hospitals, representing a major public health threat The burden of injury as a public health issue is especially pronounced in low- and middle-income countries, where injuries are responsible for up to 90% of mortality. Identifying common mechanisms of trauma and patterns of presentation can aid in identifying at-risk populations and in the development of targeted preventive protocols. Methods From February 2000 to January 2015, a prospective observational study was conducted to examine the patterns of presentation and epidemiology of patients presenting to the surgical emergency department of a University Teaching Hospital. All patients who presented during these 15 years were enrolled in the study. Results A total of 27,588 patients were admitted through the surgical emergency department during the study period. Of these, 18,374 patients (66.6%) presented with trauma, while the remaining 33.4% sought care for other surgical emergencies. Trauma patients were generally younger, with an average age of 30.27 years, compared to an average age of 41.33 years for those presenting with other surgical emergencies. Road traffic crashes accounted for the majority of injuries (65.3%), followed by falls (8.9%) and assaults (6.9%). The majority of patients (69.2%) were transported to the hospital by friends and relatives. Conclusion Injuries represent a substantial portion of the emergency surgical care demands in this setting. Road traffic injuries continue to be the predominant cause of trauma, with young adult males being the most frequent victims.
Patterns of opioid use after surgical discharge: a multicentre, prospective cohort study in 25 countries Anaesthesia, 2024 SummaryBackgroundExcessive opioid prescribing following surgery contributes to the growing opioid crisis. Prescribing practices are modifiable, yet data to guide appropriate prescription of opioids at surgical discharge remain sparse. This study aimed to evaluate factors associated with opioid consumption following discharge from surgery.MethodsAn international prospective multicentre cohort study was performed recruiting adult patients undergoing common general, orthopaedic, gynaecological and urological surgery, with follow‐up 7 days after discharge. The primary outcome measures were the quantities of prescribed and consumed opioids in oral morphine milligram equivalents. Descriptive and multivariable analyses were performed to investigate factors associated with the primary outcome measures.ResultsThis analysis included 4273 patients from 144 hospitals in 25 countries. Overall, 1311 (30.7%) patients were prescribed opioids at discharge. For those patients prescribed opioids, mean (SD) 179 (240) oral morphine milligram equivalents were prescribed, yet only 81 (145) oral morphine milligram equivalents were consumed within the first 7 days after discharge. An increased dose of opioids prescribed at discharge was associated with an increased dose of opioids consumed during the follow‐up period (β = 0.33 (95%CI 0.31–0.34), p < 0.001). The risk of prescribing more opioids than patients consumed increased as quantities of opioids prescribed at discharge exceeded 100 oral morphine milligram equivalents, independent of patient comorbidity, procedure and pain. Patients were prescribed more than twice the quantity of opioids they consumed in the first 7 days following discharge from surgery.ConclusionsOur data suggest that the current quantities of opioids provided at discharge exceed patient needs and may contribute to increasing community opioid use and circulation.
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries William Xu, Gordon Liu, Chris Varghese, Cameron Wells, Nicolas Smith, et al. British Journal of Surgery, 2024 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 &lt; 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 (β 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.
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study GlobalSurg Collaborative Covidsurg Collaborative, Ergin Erginöz, Juan J. Segura-Sampedro, Fardis Vosoughi British Journal of Surgery, 2021 Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
Neonatal lower limb gangrene: Effect of local cosmetic agent O. Salawu, G. Ibraheem, J. Mejabi, C. Nwosu, B. Ahmed, et al. Sahel Medical Journal, 2021 Limb gangrene is a common orthopedic emergency in this part of the world, but neonatal limb gangrene is a rare pathology. Sepsis is a common complication of limb gangrene which can lead to mortality if not managed early. Here is a case of left leg gangrene in a 16-day-old female neonate following the application of local cosmetic agent ("lele") by the mother prior to naming ceremony. The patient presented with features of septicemia; she was resuscitated, and left below-knee amputation was done for her. Harmful and unnecessary cosmetics should be avoided in neonates.
Major extremity amputations: Indications and post surgery challenges in a Nigeria tertiary institution OniNasiru Salawu, OM Babalola, JO Mejabi, AA Fadimu, BA Ahmed, et al. Sahel Medical Journal, 2019 Background: Amputation is an ancient procedure which has been practiced for centuries for a variety of indications. The goal of the procedure is to eliminate potential threat to the patient while producing a viable stump for easy rehabilitation. Objective: To identify the indications, postoperative complications and peculiarities of patients with amputation in a native African population. Materials and Methods: This was a prospective study carried out on all consenting patients who had extremity amputation at Federal Medical Centre, Birnin Kebbi, from June 2015 to May 2016. Results: During the study period, there were 47 amputations in 47 patients (34 males and 13 females). The mean age of the patients was 35.73 ± 19.43 years. The most common indication for amputation was traditional bone setter's (TBS) gangrene accounting for 44.7% of cases, followed by diabetic foot syndrome at 25.5%. Camel bites accounted for 6.4% of the amputations. The most common type of amputation was below-knee amputation (46.8%), followed by above-knee amputation (25.5%). Five (10.7%) patients had surgical site infection and only 2.1% of the patients developed phantom limb sensation. None of these patients was fitted with a prosthesis due to the high cost or nonavailability of the prosthesis. Conclusion: Complications of TBS intervention were the leading cause of amputation in this study. Gangrene following camel bites was also found to be a peculiar cause for amputation in this environment. Appropriate public health interventions are necessary to reduce the incidence of preventable gangrene. Provision of prosthesis with adequate technical support is essential to proper rehabilitation of the amputees.
Transforaminal epidural steroid injections for the treatment of lumbosacral radicular pain in a Nigeria tertiary hospital: Observational study ZA Suleiman, IK Kolawole, BA Ahmed, OM Babalola, GH Ibraheem Southern African Journal of Anaesthesia and Analgesia, 2018 Background: Lumbosacral radicular pain is a common cause of chronic low back pain. Despite published reports of effectiveness of transforaminal epidural steroid for lumbosacral radicular pain, it is underutilised in many tertiary hospitals in sub-Saharan Africa. This study assessed the clinical effects of transforaminal epidural steroid injections in patients with lumbosacral radicular pain at a major tertiary health facility in Nigeria. Methods: This is a prospective observational study carried out between March 2012 and February 2016. Under fluoroscopy, the epidural space was accessed through the neuroforamen using 22G spinal needles in 47 adult patients with lumbosacral radicular pain; and a mixture of 10 mg triamcinolone acetonide and 0.25% plain bupivacaine (2 mLs per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores respectively at three and six months. Results: The pain and ODI scores at baseline and at six months’ follow-up improved significantly; 8.49 ± 1.28 vs. 3.6 ± 1.5 (p = 0.002) and 45.1 ± 11.5 vs. 32.4 ± 11.5 (p = 0.001) respectively. Conclusion: Transforaminal epidural steroid injections provided significant pain relief and improved function in patients with lumbar radicular pain due to intervertebral disc herniations.
Global anaesthesia practice using inguinal hernia surgery as a tracer condition: a secondary analysis of an international prospective cohort study NIHR Global Health Research Group on Environmentally Sustainable Hospitals ... Anaesthesia 80 (11), 1343-1351 , 2025 2025 Citations: 1
Prevalence And Risk Factors of Anxiety and Depressive Disorders in Patients with Lumbar Spondylosis in Two Tertiary Health Institutions in North-central Nigeria AT Kuranga, D Sulyman, GH Ibraheem, TA Mohammed Tropical Journal of Health Sciences 32 (1), 1-8 , 2025 2025
Predicting opioid consumption after surgical discharge: a multinational derivation and validation study using a foundation model C Varghese, L Peters, L Gaborit, W Xu, K Kalyanasundaram, A Basam, ... NPJ digital medicine 8 (1), 547 , 2025 2025
Patterns of Trauma Presentation in Ilorin, Nigeria: A 15-year Review GH Ibraheem, ARA Nasir, OM Babalola, LO Abdur-Rahman, ... Ethiopian Journal of Health Sciences 35 (1), 35 , 2025 2025 Citations: 1
Patterns of opioid use after surgical discharge: a multicentre, prospective cohort study in 25 countries TASMAN Collaborative, L Gaborit, K Kalyanasundaram, J Vu, A Basam, ... Anaesthesia 79 (9), 924-936 , 2024 2024 Citations: 23
Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries AE Dönmez, AG Goswami, A Raheja, A Bhadani, AES El Kady, A Alniemi, ... The Lancet Global Health 12 (7), e1094-e1103 , 2024 2024 Citations: 26
A prognostic model for use before elective surgery to estimate the risk of postoperative pulmonary complications (GSU-Pulmonary Score): a development and validation study in … L Bravo, JFF Simões, VR Cardoso, A Adisa, ML Aguilera, A Arnaud, ... The Lancet Digital Health 6 (7), e507-e519 , 2024 2024 Citations: 9
Onychogryphosis of the finger: A case report GH Ibraheem, DM Kadir, OM Babalola, ON Salau, BA Ahmed Tropical Journal of Health Sciences 31 (1), 33-36 , 2024 2024
Epidemiology and Indications for major limb amputations in Ilorin, Nigeria GH Ibraheem, AA Nasir, LO Abdur_Rahman, OM Babalola, DM Kadir, ... Tropical Journal of Health Sciences 31 (1), 15-18 , 2024 2024 Citations: 1
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries British journal of surgery 111 (1), znad421 , 2024 2024 Citations: 10
Determinants of risk-taking behaviours among road users in Ilorin, Nigeria GH Ibraheem, AA Nasir, CKP Ofoegbu, LO Abdur-Rahman, OM Babalola, ... International Journal of Health Sciences 11 (2), 32-38 , 2023 2023 Citations: 3
Overcoming the Challenges of Orthopaedic Practice in Nigeria SB Agaja, OM Babalola, GH Ibraheem, BA Ahmed The Integrated Journal of Medicine & Medical Sciences 2 (2), 21-25 , 2023 2023
The Inter-relationship Between Nutrition and Infections in Older People: A Review GH Ibraheem, RM Ibraheem Biomed Sci 3 (3-4), 53-57 , 2022 2022
SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study C COVIDSurg, C GlobalSurg Anaesthesia: Peri-operative medicine, critical care and pain , 2022 2022 Citations: 133
Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study COVIDSurg Collaborative, GlobalSurg Collaborative, D Nepogodiev, ... Anaesthesia 76 (11), 1454-1464 , 2021 2021 Citations: 51
Prospect of Bone Xenograft as Alternate to Autologous Bone Graft: A Survey of Orthopaedic Surgeons Perspective in Nigeria OA Alimi, S Yakub, AA Abubakar, GH Ibraheem Western Journal of Medical and Biomedical Sciences 2 (2), 103-112 , 2021 2021
Neonatal lower limb gangrene: Effect of local cosmetic agent ON Salawu, GH Ibraheem, JO Mejabi, C Nwosu, BA Ahmed, AK Suleiman, ... Sahel Medical Journal 24 (2), 96-98 , 2021 2021
Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study R Ilić Anaesthesia , 2021 2021 Citations: 674
آسیب شبکه اعصاب بازویی و عروق پس از دررفتگی تحتانی شانه، گزارش یک پرونده OM Babalola, ON Salawu, BA Ahmed, GH Ibraheem مجله جراحی استخوان و مفاصل ایران 17 (2), 78-80 , 2020 2020
The Union Rate of Ankle Arthrodesis Using Double‑column Plating ON Salawu, OM Babalola, BA Ahmed, GH Ibraheem, JO Mejabi, ... Nigerian Journal of Orthopaedics and Trauma 19 (1), 23-26 , 2020 2020
MOST CITED SCHOLAR PUBLICATIONS
Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study R Ilić Anaesthesia , 2021 2021 Citations: 674
SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study C COVIDSurg, C GlobalSurg Anaesthesia: Peri-operative medicine, critical care and pain , 2022 2022 Citations: 133
Carpal tunnel syndrome and other entrapment neuropathies KW Wahab, EO Sanya, PB Adebayo, MO Babalola, HG Ibraheem Oman medical journal 32 (6), 449 , 2017 2017 Citations: 67
Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study COVIDSurg Collaborative, GlobalSurg Collaborative, D Nepogodiev, ... Anaesthesia 76 (11), 1454-1464 , 2021 2021 Citations: 51
Comparative Study of Proximal Tibia and Iliac Crest Bone Graft Donor Sites in Treatment of Orthopaedic Pathologies ON Salawu, OM Babalola, BA Ahmed, GH Ibraheem, DM Kadir Malaysian Orthopaedic Journal 11 (2), 15-19 , 2017 2017 Citations: 34
Open intramedullary nailing for segmental long bone fractures: an effective alternative in a resource restricted environment OM Babalola, GH Ibraheem, BA Ahmed, A Olawepo, SB Agaja, A Adeniyi Nigerian Journal of Surgery 22 (2), 90-95 , 2016 2016 Citations: 31
Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries AE Dönmez, AG Goswami, A Raheja, A Bhadani, AES El Kady, A Alniemi, ... The Lancet Global Health 12 (7), e1094-e1103 , 2024 2024 Citations: 26
Epidemiology of traumatic fractures in a tertiary health center in Nigeria OM Babalola, ON Salawu, BA Ahmed, GH Ibraheem, A Olawepo, ... Journal of Orthopaedics, Traumatology and Rehabilitation 10 (2), 87-89 , 2018 2018 Citations: 24
Patterns of opioid use after surgical discharge: a multicentre, prospective cohort study in 25 countries TASMAN Collaborative, L Gaborit, K Kalyanasundaram, J Vu, A Basam, ... Anaesthesia 79 (9), 924-936 , 2024 2024 Citations: 23
Clinical outcomes after open locked intramedullary nailing of closed femoral shaft fractures for adult patients in a Nigerian hospital ON Salawu, GH Ibraheem, OM Babalola, DM Kadir, BA Ahmed, SB Agaja, ... Nigerian journal of clinical practice 20 (10), 1316-1321 , 2017 2017 Citations: 22
Management and outcome of infantile hydrocephalus in a tertiary health institution in Nigeria AS Yusuf, HK Omokanye, NA Adeleke, RO Akanbi, SO Ajiboye, ... Journal of Neurosciences in Rural Practice 8 (2), 249 , 2017 2017 Citations: 21
The correlation between body mass index on the length from skin to lumbar epidural space in nigerian adults MB Adegboye, BO Bolaji, GH Ibraheem Journal of the West African College of Surgeons 7 (1), 113 , 2017 2017 Citations: 19
Evaluation of an accelerated Ponseti protocol for the treatment of talipes equinovarus in Nigeria GH Ibraheem, OO Adegbehingbe, OM Babalola, SB Agaja, BA Ahmed, ... East and Central African Journal of Surgery 22 (1), 28-38 , 2017 2017 Citations: 17
Major extremity amputations: Indications and post surgery challenges in a Nigeria tertiary institution ON Salawu, OM Babalola, JO Mejabi, AA Fadimu, BA Ahmed, ... Sahel Medical Journal 22 (1), 8-12 , 2019 2019 Citations: 14
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries British journal of surgery 111 (1), znad421 , 2024 2024 Citations: 10
A prognostic model for use before elective surgery to estimate the risk of postoperative pulmonary complications (GSU-Pulmonary Score): a development and validation study in … L Bravo, JFF Simões, VR Cardoso, A Adisa, ML Aguilera, A Arnaud, ... The Lancet Digital Health 6 (7), e507-e519 , 2024 2024 Citations: 9
Removal of Orthopaedic Hardware: A 5 year review ASB Kadir B.M.D, Ibraheem G.H, Yakub S, Onuchukwu N.S, Olawepo K, Babalola O ... Nigerian Journal of Orthopaedics and Trauma 12 (2), 113-118 , 2013 2013 Citations: 7
Transforaminal epidural steroid injections for the treatment of lumbosacral radicular pain in a Nigeria tertiary hospital: observational study ZA Suleiman, IK Kolawole, BA Ahmed, OM Babalola, GH Ibraheem Southern African Journal of Anaesthesia and Analgesia 24 (4), 109-113 , 2018 2018 Citations: 6
Challenges in the management of mucopolysaccharidosis type II (Hunter’s syndrome) in a developing country: a case report R Ibraheem, P Oladele, A AbdulAzeez, M Abdulkadri, S Katibi, ... Ethiopian Journal of Health Sciences 25 (3), 279-282 , 2015 2015 Citations: 5
Musculoskeletal tumors of the extremities: challenges and outcome of management in a Nigeria Tertiary Hospital ON Salawu, OM Babalola, GH Ibraheem, C Nwosu, AK Suleiman, ... African Journal of Medical and Health Sciences¦ Volume 17 (1) , 2018 2018 Citations: 4