Hospital Analgesia Practices and Patient-reported Pain After Colorectal Resection. Issue 6 (December 2016)

• Record Type: Journal Article
• Authors: Regenbogen, Scott E.; Mullard, Andrew J.; Peters, Nanette; Brooks, Shannon; Englesbe, Michael J.; Campbell, Darrell A.; Hendren, Samantha
• Is Part Of: Annals of surgery. Volume 264:Issue 6(2016:Dec.)
• Publication Date: 2016-12
• Subjects: analgesia -- colectomy -- HCAHPS -- pain -- patient-reported outcomes; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001541
• Languages: English
• ISSNs: 0003-4932

Abstract

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.