Perioperative factors associated with Hospital Consumer Assessment of Healthcare Providers and Systems responses of total hip arthroplasty patients.
OBJECTIVE
To determine perioperative treatments and events associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) responses among patients who undergo total hip arthroplasties (THAs) and total knee arthroplasties (TKAs).


METHODS
Retrospective analysis.


METHODS
Single tertiary care, academic, urban, level 1 trauma center.


METHODS
Final cohort represents 301 consecutive surgical inpatients meeting criteria for evaluation by HCAHPS survey.


METHODS
Responses to 4 HCAHPS questions were analyzed against perioperative treatments and events.


METHODS
Positive and negative responses to HCAHPS questions.


RESULTS
THA patients responding affirmatively to both pain specific and general satisfaction were associated with preoperative use of chronic nonsteroidal anti-inflammatory drugs. In addition, THA patients responding affirmatively "how often was your pain well controlled" were also associated decreased postanesthesia care unit (PACU) opioid requirement. TKA patients responding affirmatively to "what number would you use to rate this hospital" were associated with shorter PACU stays and lower final pain scores. TKA patients responding affirmatively to "would you recommend this hospital to your family" were associated with shorter lengths of stay in the hospital and in the PACU. TKA patients responding affirmatively to "How often did the hospital staff do everything to help with your pain" were not associated with any measured perioperative event. TKA patients responding affirmatively to "how often was your pain well controlled" were associated with older age, decreased use of preoperative chronic benzodiazepines, and increased use of preoperative midazolam.


CONCLUSIONS
These data suggest that chronic use of nonsteroidal anti-inflammatory drugs is associated with improved overall satisfaction and satisfaction with pain in THA patients. Furthermore, increased PACU opioid use was negatively associated satisfaction with pain management. Age, lengths of stay preadmission medications, anxiolytic medications, and PACU pain scores are associated with patient satisfaction with regards to both pain management and overall satisfaction in TKA patients.
Massachusetts General Hospital, Harvard School of Medicine, Boston, MA. Electronic address: dpmaher@mgh.harvard.edu.
Dermot P
DP
Maher
Cedars Sinai Medical Center, Los Angeles, CA.
Pauline
P
Woo
Cedars Sinai Medical Center, Los Angeles, CA.
Waylan
W
Wong
Cedars Sinai Medical Center, Los Angeles, CA.
Xiao
X
Zhang
Cedars Sinai Medical Center, Los Angeles, CA.
Roya
R
Yumul
Cedars Sinai Medical Center, Los Angeles, CA.
Charles
C
Louy
D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000758:Anesthesia / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006282:Health Personnel; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D019990:Perioperative Care; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008874:Midazolam
HCAHPS; NSAIDs; Opioids; Patient satisfaction; Preoperative medications