The analyses upon which this publication is based were performed under Contract 500–99-CO-01, “Utilization and Quality Control Quality Improvement Organization” for the State of Colorado, sponsored by the Centers for Medicare and Medicaid Services (formerly Health Care Financing Administration), Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor.
Postoperative Pain Management in Elderly Patients: Correlation Between Adherence to Treatment Guidelines and Patient Satisfaction
Article first published online: 26 JAN 2005
Journal of the American Geriatrics Society
Volume 53, Issue 2, pages 274–282, February 2005
How to Cite
Sauaia, A., Min, S.-j., Leber, C., Erbacher, K., Abrams, F. and Fink, R. (2005), Postoperative Pain Management in Elderly Patients: Correlation Between Adherence to Treatment Guidelines and Patient Satisfaction. Journal of the American Geriatrics Society, 53: 274–282. doi: 10.1111/j.1532-5415.2005.53114.x
- Issue published online: 26 JAN 2005
- Article first published online: 26 JAN 2005
- pain management;
- patient satisfaction;
Objectives: To evaluate pain management satisfaction in elderly postoperative patients; to define pain management strategies documented in the medical record (MR) that predict patient satisfaction.
Design: Prospective cohort.
Setting: Eight urban hospitals.
Participants: Three hundred twenty-two postsurgical patients aged 65 and older.
Measurements: Patients were surveyed regarding satisfaction with pain management in the first 24 hours postsurgery and the survey results summarized in a score. Pain management variables (patient education, pharmacological and nonpharmacological interventions, demographic variables, and surgery and anesthesia information) were abstracted from their MR. The correlation between the satisfaction score and MR variables was assessed using linear regression.
Results: Sixty-two percent of patients experienced severe postoperative pain, yet 87% reported being satisfied with the treatment. The mean satisfaction score±standard deviation was 59.3±10.8 (range 10.6–84.3; potential range 0–100, higher score=higher satisfaction). MR variables explained 14% of the satisfaction score variation. The worst pain intensity in the first 24 hours postsurgery as documented in the MR was the most powerful predictor of satisfaction. Other predictors associated with satisfaction were younger age, male sex, preoperative education, surgery type (laparotomy/thoracotomy patients were more satisfied than orthopedic patients), shorter recovery room stay, analgesic given through oral route, and morphine (compared with other opioids).
Conclusion: Pain in elderly surgical patients remains undermanaged. Simple strategies such as emphasizing preoperative education may have a large effect in pain management. This study developed a validated patient satisfaction score and a MR instrument to assist in monitoring pain management quality.