From the Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Ahmed, Ramsamooj, Mir), the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Kim), the Department of Orthopaedics and Rehabilitation (Roberts), University of Vermont Larner College of Medicine, Burlington, VT, and the Florida Orthopaedic Institute, Tampa, FL (Downes, Mir).
J Am Acad Orthop Surg. 2021 Apr 1;29(7):301-309. doi: 10.5435/JAAOS-D-20-00069.
Opiate abuse is a public health issue linked to prescribing. Prescribing increased partly in response to adopting pain as the fifth vital sign. Assessing pain control on patient satisfaction surveys, including government-mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and optional private surveys (Press Ganey) administered on hospital discharge, may contribute. This study evaluates whether opiate amounts affect orthopaedic trauma patient perception of pain control and overall hospital rating on HCAHPS and Press Ganey surveys.
Consecutive adult patients >18 years surgically treated for isolated fractures (UE = upper extremity, LE = lower extremity, and PA = pelvis/acetabulum) at a level 1 trauma center between January 1, 2014, and December 31, 2016, were retrospectively analyzed. Hospital charts, HCAHPS, and Press Ganey data were reviewed; patients without survey responses were excluded. Data included comorbidities, psychiatric history, substance use, injury type, and surgery. Analysis included Spearman's rho for correlations, Wilcoxon rank-sum and Kruskal-Wallis for continuous variables, and adjusted ordinal regression to estimate association between opioid prescribing and patient ratings.
One hundred fifty-two total patients (UE 29, LE 112, and PA 11) with mean age of 57 years and median length of stay 3 days were included. Adjusted models showed longer duration outpatient prescriptions were associated with lower rating on how often inpatient pain was controlled (P = 0.002), lower total MME inpatient was associated with higher ratings (HCAHPS P = 0.015; Press Ganey, P = 0.03), lower average daily MME inpatient was associated with lower ratings (HCAHPS P = 0.008; Press Ganey, P = 0.037), and shorter outpatient prescription duration was associated with lower ratings (P = 0.008). Patient perception of pain control was strongly associated with overall HCAHPS (P < 0.05) and Press Ganey (P < 0.001) ratings.
Inpatient and outpatient opiate amounts and duration demonstrated some associations with overall scores. However, patients' pain control perception seems to have the strongest relationship with hospital rating. Counseling and multimodal pain control may lead to strong satisfaction scores without needing high opiates after orthopaedic trauma.
阿片类药物滥用是一个与处方有关的公共卫生问题。处方量的增加部分是由于将疼痛作为第五大生命体征而做出的回应。在出院时评估疼痛控制情况，包括政府要求的医院患者评估医疗保健提供者和系统（HCAHPS）和可选的私人调查（民意调查），可能会有所帮助。这项研究评估了阿片类药物的用量是否会影响骨科创伤患者对疼痛控制的感知以及在 HCAHPS 和民意调查中的整体医院评分。
回顾性分析 2014 年 1 月 1 日至 2016 年 12 月 31 日期间在一家一级创伤中心接受手术治疗的连续成年患者的病历、HCAHPS 和民意调查数据；排除没有调查回复的患者。数据包括合并症、精神病史、药物滥用、损伤类型和手术。分析包括 Spearman's rho 进行相关性分析、Wilcoxon 秩和和 Kruskal-Wallis 进行连续变量分析，以及调整后的有序回归来估计阿片类药物处方与患者评分之间的关联。
共纳入 152 名患者（UE 29、LE 112 和 PA 11），平均年龄 57 岁，中位住院时间为 3 天。调整后的模型显示，门诊处方持续时间较长与住院期间疼痛控制频率评分较低有关（P = 0.002），住院期间平均每日 MME 较低与评分较高有关（HCAHPS P = 0.015；民意调查，P = 0.03），住院期间平均每日 MME 较低与评分较低有关（HCAHPS P = 0.008；民意调查，P = 0.037），门诊处方持续时间较短与评分较低有关（P = 0.008）。患者对疼痛控制的感知与整体 HCAHPS（P < 0.05）和民意调查（P < 0.001）评分密切相关。
住院和门诊阿片类药物的数量和持续时间与整体评分有一定的关联。然而，患者的疼痛控制感知似乎与医院评分的关系最强。在骨科创伤后，通过咨询和多模式疼痛控制，可以获得强烈的满意度评分，而无需使用大量阿片类药物。
