American Association for Hand Surgery

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Prescription opioids and patient satisfaction after carpal tunnel release surgery
Pragna N. Shetty, MPH, Madhuli Y Thakkar, MPH, Imran S. Yousaf, DO and Aviram M Giladi, MD, MS, The Curtis National Hand Center, Baltimore, MD

Introduction: Patient satisfaction is an increasingly used metric for evaluating health care services and can impact system changes as well as compensation and reimbursement. The opioid epidemic has spurred efforts to limit opioid prescriptions; however, these limits bring concerns about inadequate pain control and related effects on patient satisfaction. We examined the association between prescription opioid pain medication after carpal tunnel release surgery (CTR), pain scores, and satisfaction scores.

Materials/Methods: All patients over age 18 who underwent CTR at our hand center between January 1, 2018 and May 31, 2019 were included. Patient-reported pain level, satisfaction, and continued postsurgical prescription pain medication use at 2-week follow-up visit were collected prospectively. Satisfaction and pain were scored by the patient from 1-10; 10 is highest satisfaction, and 10 is highest pain score. Fisher's exact test was used for analysis.

Results: 505 patients were included. The mean age was 56.7 (22.0-91.8) years, with 335 (66.3%) females and 170 (33.7%) males. 405 patients were given a prescription for pain medication after surgery, and 100 were discharged with no prescription. Postoperatively, the median pain score for the prescription and no-prescription groups was not significantly different (P=0.79, Figure 1). However, the median pain score at follow-up for those who remained on prescription pain medicine (N=67) was 2 points higher than the score for those who had discontinued their prescription (P<0.001). Median satisfaction score at follow-up for patients who received a prescription was not significantly different from scores of patients who did not receive a prescription (P=0.77). For patients who remained on a prescription, median satisfaction scores were 1.5 points lower than the scores for those who discontinued their prescription (P<0.001).

Conclusions: Overall, many patients do well after CTR with minimal or no prescription pain medicine. However, patients who received and remained on a prescription after CTR reported higher pain levels and lower satisfaction scores. These patients may require additional support and should be identified early. Further research into this high-risk patient subgroup is needed to identify resources and alternative pain management strategies, and to guide policy around using satisfaction scores as a measure of quality.





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