[Patient-related factors and professional practices associated with postoperative pain].
BACKGROUND
Unrelieved postoperative pain is reported despite of widely defined standards for postoperative pain management. The objective of this study was to identify the relationship between patient characteristics, medical practices and outcomes (severe post-operative pain and patient satisfaction).


METHODS
Using a cross-sectional observational study in 18 departments of adult surgery from 5 hospitals, medical records were audited according to a set of explicit criteria (patient characteristics and professional practices). Postoperative pain severity was measured with a 0 to 10 visual numerical scale and patient satisfaction using a six-level verbal rating scale (from very satisfied to very unsatisfied). The surgical procedures were classified into three levels of expected severe pain frequency (high, median, low). The relation between severity of pain, satisfaction on one hand, and process and patient characteristics on the other, was studied with chi(2)-test and logistic regression.


RESULTS
625 patients were included. 41.8% suffered from postoperative pain and 81.6% were satisfied. Pain measurement before leaving the postoperative anesthesia care unit (p<0.02) and protocols for analgesia in painful surgery (p<0.05) were associated with a lower frequency of pain. Three patient characteristics were associated with a higher frequency of severe postoperative pain: painful surgical procedure (p<0.001), mental pain (p<0.005), and preoperative pain (p<0.0001). The lack of administration of analgesia was a major explicative factor: 64% of patients with severe postoperative pain, did not receive all analgesics ordered. Patient satisfaction was higher when the patient was requested to notify pain (p<0.05) before surgery and lower after painful surgical procedures (p<0.05).


CONCLUSIONS
There are two ways to improve pain management: first the quality of the analgesic prescription particularly for painful surgical procedures and secondly the administration of the prescribed analgesia.
Poisson-Salomon
A-S
AS
Direction du système Qualité, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris Cedex 15. anne-sylvie.poisson-salomon@nck.aphp.fr
De Chambine
S
S
Lory
C
C
D000700:Analgesics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D008485:Medical Audit; D008499:Medical Records; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index
D000700:Analgesics