M. Flannery1, S. Stokes1, A. Jacobs1, T. Varghese1, R. Glasgow1, B. S. Brooke1, L. C. Huang1 1University Of Utah,General Surgery,Salt Lake City, UT, USA
Introduction:
In the era of patient-reported outcomes, patient satisfaction has become a key quality metric for grading providers and hospitals. A patient’s postoperative pain experience can affect these metrics. Providers may be tempted to prescribe excess pain medications to improve patient satisfaction scores. We hypothesized that satisfaction with pain control was not related to the quantity of opioids prescribed to the patient at discharge.
Methods:
We designed a prospective observational study to evaluate post-operative opioid prescribing and satisfaction among patients undergoing a broad spectrum of general, vascular, colorectal, and plastic surgery procedures at a single tertiary academic medical center. All patients received a survey to determine opioid use and satisfaction with pain control at their first post-operative follow-up visit. We extracted the quantity of opioids prescribed at discharge (normalized to hydrocodone 5 mg tablets) from the electronic medical records. Post-operative pain control satisfaction was compared with the quantity of opioids prescribed at discharge. We constructed hierarchical, mixed effects models using forward step-wise variable selection clustered by procedure to identify risk factors for patient dissatisfaction with pain control while adjusting for potential patient- and procedure-level confounders.
Results:
A total of 346 patients were contacted following surgery, and 289 patients completed the survey (response rate 84%). The distribution by specialty was 33% general, 22% vascular, 20% colorectal, 12% surgical oncology, 7% plastics, and 6% foregut. 83% of patients were satisfied with their pain control, 6% neutral, and 11% were dissatisfied. The median quantity of opioids prescribed normalized to hydrocodone 5mg tablets was 30 (IQR 15-40). After adjustment for time to follow-up, procedure, operative approach (e.g., open versus minimally invasive), and inpatient/outpatient stay, there was no statistical difference in the median number of opioids prescribed to dissatisfied patients compared to satisfied or neutral patients (41.7 ± 5.5 tabs vs. 33.1 ± 2.6 tabs, respectively; p=0.123). On univariate analysis, patient risk factors associated with dissatisfaction with pain control were past opioid use (p = 0.015), smoking history (p < 0.001), current alcohol use (p = 0.049), history of sexual abuse (p = 0.003), and history of attention deficit disorder (p = 0.015). After adjustment using multivariable regression models, we found a significant association between dissatisfaction and past opioid use (OR 3.33, 95% CI 1.12-9.94) and current alcohol use (OR 3.77, 95% CI 1.16-12.22).
Conclusion:
Prescribing more opioids in this study was not associated with greater patient satisfaction after surgery. Patients with past opioid or alcohol use are more likely to be dissatisfied with their pain control. Further research is needed on how to improve pain control and satisfaction in this challenging patient population.