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.
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: David A Share; Darrell A Campbell; Nancy Birkmeyer; Richard L Prager; Hitinder S Gurm; Mauro Moscucci; Marianne Udow-Phillips; John D Birkmeyer Journal: Health Aff (Millwood) Date: 2011-04 Impact factor: 6.301
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Authors: Federico Coccolini; Francesco Corradi; Massimo Sartelli; Raul Coimbra; Igor A Kryvoruchko; Ari Leppaniemi; Krstina Doklestic; Elena Bignami; Giandomenico Biancofiore; Miklosh Bala; Ceresoli Marco; Dimitris Damaskos; Walt L Biffl; Paola Fugazzola; Domenico Santonastaso; Vanni Agnoletti; Catia Sbarbaro; Mirco Nacoti; Timothy C Hardcastle; Diego Mariani; Belinda De Simone; Matti Tolonen; Chad Ball; Mauro Podda; Isidoro Di Carlo; Salomone Di Saverio; Pradeep Navsaria; Luigi Bonavina; Fikri Abu-Zidan; Kjetil Soreide; Gustavo P Fraga; Vanessa Henriques Carvalho; Sergio Faria Batista; Andreas Hecker; Alessandro Cucchetti; Giorgio Ercolani; Dario Tartaglia; Joseph M Galante; Imtiaz Wani; Hayato Kurihara; Edward Tan; Andrey Litvin; Rita Maria Melotti; Gabriele Sganga; Tamara Zoro; Alessandro Isirdi; Nicola De'Angelis; Dieter G Weber; Adrien M Hodonou; Richard tenBroek; Dario Parini; Jim Khan; Giovanni Sbrana; Carlo Coniglio; Antonino Giarratano; Angelo Gratarola; Claudia Zaghi; Oreste Romeo; Michael Kelly; Francesco Forfori; Massimo Chiarugi; Ernest E Moore; Fausto Catena; Manu L N G Malbrain Journal: World J Emerg Surg Date: 2022-09-21 Impact factor: 8.165