A temporal analysis of opioid use, patient satisfaction, and pain scores in colorectal surgery patients.
BACKGROUND
Recent health care policy changes promote objective measurements of patient satisfaction with care provided during hospitalization. Acute postsurgical pain is a significant medical problem and strongly impacts patient experience and patient satisfaction. Multimodal analgesic pathways are used for acute pain management, but opioid medications remain a mainstay of treatment. Opioid use is increasing in the outpatient setting, but opioid use trends in the inpatient postsurgical setting are not well known. We hypothesized that use of opioid medications has increased over time along with decrease in postoperative pain scores and increase in pain-related patient satisfaction.


METHODS
In this single-center study, we studied the trends and correlation in the average daily pain scores, opioid consumption, and patient satisfaction scores as measured by pain-related patient satisfaction questions in the Hospital Consumer Assessment of Healthcare Providers and System survey. Pain scores and opioid use data were obtained from electronic health records, vital signs monitoring, and medication databases. Adult patients who had nonemergent colorectal surgeries between January 2009 and December 2012 were included.


RESULTS
We found no significant trend in opioid use or pain-related patient satisfaction scores. There was an average annual increase of 0.3 (98.3% confidence interval, 0.2-0.4; P< .001) in average daily pain score from 2.8 ± 1.5 to 3.8 ± 1.5. The univariable associations between time-weighted pain score, average daily opioid dose, and pain-related patient satisfaction score were all highly significant.


CONCLUSIONS
In this retrospective cohort study, opioid use and pain-related patient satisfaction scores were stable over time. Pain-related patient satisfaction scores were negatively associated with both pain score and opioid dose. The associations we report should not be considered evidence of a causal relationship.
Department of General Anesthesiology, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH. Electronic address: Maheshk@ccf.org.
Kamal
K
Maheshwari
Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Kenneth C
KC
Cummings
Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Ehab
E
Farag
Department of Outcomes Research, Cleveland Clinic, Cleveland, OH.
Natalya
N
Makarova
Department of General Anesthesiology, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Alparslan
A
Turan
Department of General Anesthesiology, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Andrea
A
Kurz
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003106:Colon / Q000601:surgery*; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods / Q000639:trends*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies
D000701:Analgesics, Opioid
Acute pain; Colorectal surgery; Opioids; Patient satisfaction