Self-Reported Recovery Likelihood Predicts Higher Physician Ratings: A Survey of Patients After Orthopaedic Surgery.

OBJECTIVES: What are the differences between elective and trauma patient satisfaction and do patient and diagnosis factors predict physician scores? DESIGN: Prospective cohort study. SETTING: Urban Level 1 Trauma center. PATIENTS/PARTICIPANTS: Three hundred twenty-three trauma patients and 433 elective orthopaedic patients treated at our center by the same surgeons. INTERVENTION: Trauma patients treated surgery for one or more fractures; elective patients treated with hip, knee, or shoulder arthroplasty, or rotator cuff repair. MAIN OUTCOME MEASUREMENTS: Telephone survey regarding patient experience and satisfaction with their care. The survey included questions from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and responses were rated on a 1-5 point Likert scale (5 best). RESULTS: Elective surgery patients had mean age of 56.4 years, and trauma patients were mean 50.3 years of age. Trauma patients rated their likelihood to make a full recovery lower than elective patients (median, interquartile range), 5.0 (1.0) versus 4.0 (2.0) (P < 0.001). After multivariate binary logistic regression, patients who rated the hospital higher (≥4 vs. ≤3) were more likely (odds ratio = 10.0, 95% confidence interval, 6.4-15.8) to score physicians better. Similarly, patients who scored their overall likelihood of recovering ≥4 compared with ≤3 were more likely (odds ratio = 3.6, 95% confidence interval, 2.9-5.6) to rate their physicians more positively. CONCLUSIONS: Patient perceptions including their likelihood to make a full recovery and their overall impression of the hospital predicted higher physician scores. We conclude that these physician scores are subject to patient perception biases and are not independent of the overall care experience. We recommend HCAHPS and physician ratings' web sites include internal controls, such as the patient perception of overall likelihood to recover, to aid in interpreting survey results.

Traumatic Orthopaedic Injury Is Not an Independent Risk Factor for High Postdischarge Opioid Consumption.

INTRODUCTION: The purpose of this study was to quantify how opioid use in patients with traumatic injury compared with opioid use in patients undergoing elective arthroplasty. METHODS: In a retrospective review, 235 adult trauma patients treated surgically for fracture were compared with 98 patients undergoing elective total hip or knee arthroplasty. Inpatient, discharge, and postdischarge opioid use were recorded in oral morphine equivalents (OMEs). RESULTS: There were no differences between trauma and elective arthroplasty patients for inpatient opioid use (OME/day: 70.2 vs. 67.3; P = 0.53), discharge prescription (OME: 542 vs. 594; P = 0.13), or postdischarge opioid use (OME: 986 vs. 1,147; P = 0.29). Postdischarge opioid use was positively correlated with Caucasian race, intensive care unit admission, baseline alcohol or opioid use, and higher discharge prescriptions (P < 0.0001; adjusted R2 = 0.127). Discharge prescription amount was the most significant predictor. DISCUSSION: Traumatic injury is not a predictor of high post-discharge opioid use. Demographic, social, and physician prescribing behaviors contribute to higher postdischarge opioid consumption.