Evaluation of the Determinants of Satisfaction With Postoperative Pain Control After Thoracoscopic Surgery: A Single-Center, Survey-Based Study

• Published in: Anesthesia and analgesia Vol. 128; no. 3; pp. 555 - 562
• Main Authors: Siu, Emily, Quick, John S., Xu, Xinling, Correll, Darin J.
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.03.2019
• Subjects: Aged; Female; Humans; Male; Middle Aged; Pain Management - methods; Pain Management - standards; Pain Measurement - methods; Pain Measurement - standards; Pain, Postoperative - diagnosis; Pain, Postoperative - prevention & control; Patient Satisfaction; Prospective Studies; Quality Improvement - standards; Quality Improvement - trends; Surveys and Questionnaires - standards; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - trends
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000003756

BACKGROUND:The need to measure, compare, and improve the quality of pain management is important to patients, payers, and health care providers. Pain after thoracic surgery can be severe, and thoracoscopic approaches have not had the favorable impact on pain as anticipated. The aim of this study was to evaluate the determinants of patient satisfaction with acute pain management and the effectiveness of pain control after video-assisted thoracoscopic surgery using a modified version of the Revised American Pain Society Patient Outcome Questionnaire. METHODS:We performed a single-center, prospective, survey-based study of 300 patients who had undergone elective video-assisted thoracoscopic surgery. Patients were enrolled and completed the survey on postoperative day 1 or 2. The primary outcome variable was patient-reported satisfaction with acute postoperative pain treatment measured on a 1–4 scale. The relationship between the items on the survey and patient satisfaction was analyzed to determine the factors significantly associated with satisfaction. RESULTS:Fifty-one percent of the patients had the highest satisfaction level with pain treatment, and 4% of the patients had the lowest satisfaction level. The mean reported acceptable pain level was 3.8 ± 1.9 (numeric rating scale [NRS], 0–10). The average pain intensity score at the time of the survey was 2.8 ± 2.1 (NRS, 0–10). The median for the most pain in the prior 24 hours was 7 (NRS, 0–10; interquartile range, 5–9). Five items from the survey were significantly associated with the satisfaction level. The predictor with the highest associated odds ratio (OR) with satisfaction was the ability to participate in pain management decisions (OR, 1.45; P < .0001). Another positively associated predictor was receiving helpful information about pain treatment options (OR, 1.31; P = .002). Negatively associated predictors of patient satisfaction included level of pain intensity at time of survey (OR, 0.76; P = .002), lowest pain score in the prior 24 hours (OR, 0.70; P = .0006), and having pain interfere with sleep in the postoperative period (OR, 0.72; P = .037). CONCLUSIONS:Our findings highlight several factors associated with patient satisfaction with acute postoperative pain management. Interventions focused on achieving acceptable pain levels for the majority of the time, ensuring that patients are able to get sleep, providing patients with helpful information about their pain treatment, and, most importantly, allowing patients to participate in decisions about their pain management may improve patient satisfaction with postoperative pain management.