title: Hospital Analgesia Practices and Patient-reported Pain After Colorectal Resection.
abstract: OBJECTIVE
  The aim of the study was to characterize patient-reported outcomes of analgesia practices in a population-based surgical collaborative.
  
  
  BACKGROUND
  Pain control among hospitalized patients is a national priority and effective multimodal pain management is an essential component of postoperative recovery, but there is little understanding of the degree of variation in analgesia practice and patient-reported pain between hospitals.
  
  
  METHODS
  We evaluated patient-reported pain scores after colorectal operations in 52 hospitals in a state-wide collaborative. We stratified hospitals by quartiles of average pain scores, identified hospital characteristics, pain management practices, and clinical outcomes associated with highest and lowest case-mix-adjusted pain scores, and compared against Hospital Consumer Assessment of Healthcare Providers and Systems pain management metrics.
  
  
  RESULTS
  Hospitals with the lowest pain scores were larger (503 vs 452 beds; P < 0.001), higher volume (196 vs 112; P = 0.005), and performed more laparoscopy (37.7% vs 27.2%; P < 0.001) than those with highest scores. Their patients were more likely to receive local anesthesia (31.1% vs 12.9%; P < 0.001), nonsteroidal anti-inflammatory drugs (33.5% vs 14.4%; P < 0.001), and patient-controlled analgesia (56.5% vs 22.8%; P < 0.001). Adverse postoperative outcomes were less common in hospitals with lowest pain scores, including complications (20.3% vs 26.4%; P < 0.001), emergency department visits (8.2% vs 15.8%; P < 0.001), and readmissions (11.3% vs 16.2%; P = 0.01).
  
  
  CONCLUSIONS
  Pain management after colorectal surgery varies widely and predicts significant differences in patient-reported pain and clinical outcomes. Enhanced postoperative pain management requires dissemination of multimodal analgesia practices. Attention to patient-reported outcomes often omitted from surgical outcomes registries is essential to improving quality from the patient's perspective.
authors.affiliation: *Department of Surgery†Center for Healthcare Outcomes and Policy‡Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mullard
authors.forename: Nanette
authors.initials: N
authors.lastname: Peters
authors.forename: Shannon
authors.initials: S
authors.lastname: Brooks
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
mesh_terms: D000368:Aged; D000698:Analgesia / Q000379:methods*; D003953:Diagnosis-Related Groups; D013505:Digestive System Surgical Procedures; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome