Ryan Kim, Dr. Adil Shahzad Ahmed, Harry Ramsamooj, Dr. Michael Roberts, Dr. Katheryne Downes, Dr. Hassan Riaz Mir
University of South Florida MCOM
Purpose: Opiate use is a major public health issue. Prescribing of opiates grew partly in response to adoption of pain as the fifth vital sign and inclusion of pain control as part of patient satisfaction surveys. These include the government-mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and surveys by private companies (Press Ganey) administered upon hospital discharge. The present study evaluates whether opiate amounts (inpatient and outpatient) impact orthopaedic trauma patient perception of pain control and overall hospital rating on HCAHPS and Press Ganey surveys. Methods: All consecutive adult patients >18y surgically treated for isolated fractures at a Level 1 Trauma Center between Jan 1, 2014-Dec 31, 2016 were retrospectively analyzed. Hospital charts, HCAHPS, and Press Ganey data were reviewed; patients without available survey responses were excluded. Patient data included comorbidities, psychiatric history, substance use, type of injury, and type of surgery. Statistical analysis included Spearman’s Rho for correlations, Wilcox Rank-Sum and Kruskal-Wallis, Backwards Stepwise Regression and Ordinal Regression with bootstrapped confidence intervals for odds assessment. Results: 152 total patients with mean age 57 and median length of stay 3 days were included. Median inpatient morphine milligram equivalents (MME) received per day was 50, and outpatient prescribed MME per day was 75. No significant differences existed between injury, comorbidities, psychiatric history, substance use, or surgery. No significant relationship existed between inpatient received dose or outpatient prescribed dose and pain control perception or overall hospital ratings on HCAHPS or Press Ganey survey. A significant relationship between pain control perception and overall hospital score on both HCAHPS (p<0.001) and Press Ganey (p<0.001) was found, with adjusted odds of 3.56 (CI 1.59-7.94) and 5.54 (2.64-11.61), respectively, for high overall HCAHPS and Press Ganey hospital rating. Conclusion: Inpatient and outpatient opiate amounts were not associated with patient perception of pain control or overall satisfaction scores. However, a strong relationship exists between patient perception of pain control and their overall rating of the hospital in both HCAHPS and Press Ganey surveys. Counseling and multimodal pain control may lead to strong patient satisfaction scores without high levels of opiate use after orthopaedic trauma.