Opioid Use After Fracture Surgery Correlates With Pain Intensity and Satisfaction With Pain Relief

被引:136
作者
Bot, Arjan G. J. [1 ]
Bekkers, Stijn [2 ]
Arnstein, Paul M. [3 ]
Smith, R. Malcolm [4 ]
Ring, David [5 ]
机构
[1] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Orthopaed Hand & Upper Extrem Serv, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Orthopaed Hand & Upper Extrem Serv, Boston, MA 02114 USA
[3] Massachusetts Gen Hosp, Boston, MA 02114 USA
[4] Harvard Univ, Massachusetts Gen Hosp, Partners Orthopaed Trauma Serv, Orthopaed Trauma Serv,Dept Orthopaed Surg,Med Sch, Boston, MA 02114 USA
[5] Harvard Univ, Massachusetts Gen Hosp, Dept Orthopaed Surg,Yawkey Ctr, Orthopaed Hand & Upper Extrem Serv,Med Sch, Boston, MA 02114 USA
关键词
PATIENT SATISFACTION; HEALTH-CARE; OPERATIVE TREATMENT; POSTOPERATIVE PAIN; MANAGEMENT; QUESTIONNAIRE; EXPERIENCES; CONSUMPTION; DEPRESSION; HOSPITALS;
D O I
10.1007/s11999-014-3660-4
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
In 2012, Medicare began to tie reimbursements to inpatient complications, unplanned readmissions, and patient satisfaction, including satisfaction with pain management. We aimed to identify factors that correlate with (1) pain intensity during a 24-hour period after surgery; (2) less than complete satisfaction with pain control; (3) less than complete satisfaction with staff attention to pain relief while in the hospital; and we also wished (4) to compare inpatient and discharge satisfaction scores. Ninety-seven inpatients completed measures of pain intensity (numeric rating scale), satisfaction with pain relief, self-efficacy when in pain, and symptoms of depression days after operative fracture repair. The amount of opioid used in oral morphine equivalents taken during the prior 24 hours was calculated. Through initial bivariate and then multivariate analysis, we identified factors that were associated with pain intensity, less than complete satisfaction with pain control, and less than complete satisfaction with staff attention to pain relief. Patients who took more opioids reported greater pain intensity (r = 0.38). No factors representative of greater nociception (fracture type, number of fractures, days from injury to surgery, days from surgery to enrollment, or type of surgery) correlated with greater pain intensity. The best multivariable model for greater pain intensity included: depression or anxiety disorder (p = 0.019), smoking (0.047), and greater opioid intake (p = 0.001). Multivariable analysis for less than ideal satisfaction with pain control included the Pain Self-Efficacy Questionnaire (PSEQ) (odds ratio [OR], 0.95; 95% CI, 0.92-0.99) alone; for less than ideal satisfaction with staff attention to pain control, the PSEQ (OR, 0.96; 95% CI, 0.92-0.99) and opioid medication use before admission (OR, 3.6; 95% CI, 1.1-12) were included. After operative fracture treatment, patients who take more opioids report greater pain intensity and less satisfaction with pain relief. Greater self-efficacy was the best determinant of satisfaction with pain relief. Evidence-based interventions to increase self-efficacy merit additional study for the management of postoperative pain during recovery from a fracture. Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
引用
收藏
页码:2542 / 2549
页数:8
相关论文
共 42 条
[1]   Acute pain management for patients receiving maintenance methadone or buprenorphine therapy [J].
Alford, DP ;
Compton, P ;
Samet, JH .
ANNALS OF INTERNAL MEDICINE, 2006, 144 (02) :127-134
[2]  
[Anonymous], 2005, GUID MAN CANC PAIN A
[3]   Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged [J].
Apfelbaum, JL ;
Chen, C ;
Mehta, SS ;
Gan, TJ .
ANESTHESIA AND ANALGESIA, 2003, 97 (02) :534-540
[4]  
Bostrom B M, 1997, J Nurs Manag, V5, P341, DOI 10.1046/j.1365-2834.1997.00031.x
[5]  
Bot Arjan G J, 2013, Hand (N Y), V8, P210, DOI 10.1007/s11552-013-9511-z
[6]   Validation of Phone Administration of Short-Form Disability and Psychology Questionnaires [J].
Bot, Arjan G. J. ;
Becker, Stephanie J. E. ;
Mol, Marianne F. ;
Ring, David ;
Vranceanu, Ana-Maria .
JOURNAL OF HAND SURGERY-AMERICAN VOLUME, 2013, 38A (07) :1383-1387
[7]   The measurement of patients' expectations for health care: a review and psychometric testing of a measure of patients' expectations [J].
Bowling, A. ;
Rowe, G. ;
Lambert, N. ;
Waddington, M. ;
Mahtani, K. R. ;
Kenten, C. ;
Howe, A. ;
Francis, S. A. .
HEALTH TECHNOLOGY ASSESSMENT, 2012, 16 (30) :1-+
[8]   Multiple imputation was an efficient method for harmonizing the Mini-Mental State Examination with missing item-level data [J].
Burns, Richard A. ;
Butterworth, Peter ;
Kiely, Kim M. ;
Bielak, Allison A. M. ;
Luszcz, Mary A. ;
Mitchell, Paul ;
Christensen, Helen ;
Von Sanden, Chwee ;
Anstey, Kaarin J. .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2011, 64 (07) :787-793
[9]  
Bush Haydn, 2011, Hosp Health Netw, V85, P22
[10]  
Carragee E J, 1999, Am J Orthop (Belle Mead NJ), V28, P97