The Incidence and Severity of Postoperative Pain following Inpatient Surgery

Objective. In recent years, there has been increased attention to pain management after surgery in the hospital setting along with financial enticement from the US government. The aim of this study is to evaluate the current efficacy of postoperative pain management. Methods. In a prospective study, patients in an academic private nonprofit medical center were asked the same questions about their postoperative pain as in a previously published 2003 survey. Questionnaires on 1) pain intensity on a verbal categorical scale and 2) patient satisfaction with pain medication were completed in the patient's room before hospital discharge, and followed-up by telephone interviews at 1 and 2 weeks later. Numerical Pain Scale (NRS) pain scores were obtained at the same time points. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results for pain management were obtained at bedside interview along with standard mailed HCAHPS survey obtained by Press Ganey. Results. Based on 441 surgical inpatients (Orthopedic, General, Neurosurgery, Gynecological) 12% of patients had "Severe-to-Extreme" pain and 54% had "Moderate-to-Extreme" pain at discharge. During the first 2 weeks after discharge, 13% of patients had "Severe-to-Extreme" pain and 46% had "Moderate-to-Extreme" pain. Pain scores at discharge and after discharge were negatively correlated with patient satisfaction with pain medication (P<0.0001), indicating that increased pain intensity was associated with decreased patient satisfaction. For the HCAHPS question "how often was your pain well controlled?," 66% answered "Always" in the Press Ganey report versus 51% at bedside (P<0.0001). Conclusions. The incidence of severe-to-extreme pain in patients before and after discharge following inpatient surgery is 12-13%, and this is a reduction from 10 years ago.