Anesthesia-related care dissatisfaction: a cohort historical study to reveal related risks

Okuda, Chie; Inoue, Satoki; Kawaguchi, Masahiko

doi:10.1016/j.bjane.2021.02.006

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Brasil

Brazilian Journal of Anesthesiology

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Brasil

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Sumário

Clinical Research • para Braz. J. Anesthesiol. 71 (2) • Mar-Apr 2021 • https://doi.org/10.1016/j.bjane.2021.02.006 copy

Anesthesia-related care dissatisfaction: a cohort historical study to reveal related risks

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Most previous reports have used questionnaires to investigate patient satisfaction regarding anesthesia-related care. We retrospectively investigated the dissatisfaction rate for anesthesia and the contributing factors for it using a questionnaire including anesthesia-related adverse events and a simplified patient satisfaction scale.

Methods:

This is a retrospective review of an institutional registry containing 21,606 anesthesia cases. We conducted multivariate logistic analysis in 9,429 patients using the incidence of dissatisfaction as a dependent variable and other covariates, including items of anesthesia registry and a postoperative questionnaire, as independent variables to investigate factors significantly associated with the risk of dissatisfaction with anesthesia.

Results:

In the study population, 549 patients rated the anesthesia service as dissatisfactory. Multivariate analysis identiﬁed the preoperative presence of coexisting disease [odds ratio (OR), 1.29; 95% conﬁdence interval (CI), 1.05–1.59], combination of regional anesthesia (OR, 1.44; 95% CI, 1.10–1.88), self-reported awareness (OR, 1.99; 95% CI, 1.29–3.06), postoperative nausea and vomiting (PONV) (OR, 1.54; 95% CI, 1.25–1.90), occurrence of nightmares (OR, 1.96; 95% CI, 1.52–2.53), and the number of days taken to visit a postoperative anesthesia consultation clinic (OR, 1.01; 95% CI, 1.00–1.02) to be independently associated with dissatisfaction with anesthesia service.

Conclusions:

Patients with coexisting disease, undergoing a combination of regional anesthesia, with self-reported awareness, experiencing PONV, suffering from nightmares, and who took longer to visit a postoperative anesthesia consultation clinic tended to rate our anesthesia service as dissatisfactory. Although the exact reasons for the factors contributing to dissatisfaction are unknown, this study suggests that there is room to improve our service.

KEYWORDS
Anesthesia department, Hospital; Patient satisfaction; Administrative claims, Healthcare

	Dissatisfaction (n = 549)	No dissatisfaction (n = 8,880)	p-value
Age (years)	57.5 (17.8)	58.8 (17.2)	0.093a
Sex (M/F)	246/303	4170/4710	0.333
Hight (cm)	159.4 (9.2)	160.0 (9.2)	0.438
Weight (kg)	58.1 (12.9)	58.6 (12.5)	0.450
ASA physical status (1-5)	2 (1-2)	2 (1-2)	0.326
Coexisting disease (Y/N)	336/213	4948/3932	0.013^a a Variables marked with an asterisk were entered into the logistic regression model.
Duration of anesthesia (min)	251 (149)	255 (152)	0.473
Duration of surgery (min)	187 (137)	192 (140)	0.433
Surgical intensity (1-3)	2 (2-2)	2 (2-2)	0.931
Emergency (Y/N)	82/467	1230/7650	0.484
ICU admission (Y/N)	116/433	1625/7255	0.1^a a Variables marked with an asterisk were entered into the logistic regression model.
Inhalational anesthesia (Y/N)	413/136	6943/1937	0.111^a a Variables marked with an asterisk were entered into the logistic regression model.
Postoperative analgesia (Y/N)	166/383	2887/5993	0.28
Combination of regional anesthesia (Y/N)	127/422	1738/7142	0.047^a a Variables marked with an asterisk were entered into the logistic regression model.
Surgical posture (Supine) (Y/N)	442/107	7035/1845	0.515
Resident management (Y/N)	308/241	5083/3797	0.625
Difficult airway (Y/N)	25/524	298/8582	0.145^a a Variables marked with an asterisk were entered into the logistic regression model.
Transfusion (Y/N)	73/476	1190/7690	1
Intraoperative adverse event (Y/N)	3/546	28/8852	0.424
Self-reported awareness (Y/N)	34/515	277/8603	< 0.0001^a a Variables marked with an asterisk were entered into the logistic regression model.
Memory of extubation (Y/N)	55/494	650/8230	0.024^a a Variables marked with an asterisk were entered into the logistic regression model.
Dental injury (Y/N)	8/541	80/8800	0.172^a a Variables marked with an asterisk were entered into the logistic regression model.
PONV (Y/N)	180/369	2091/6789	< 0.0001^a a Variables marked with an asterisk were entered into the logistic regression model.
Hoarseness (Y/N)	253/296	3476/5404	0.0013^a a Variables marked with an asterisk were entered into the logistic regression model.
Sore throat (Y/N)	253/296	3534/5346	0.004^a a Variables marked with an asterisk were entered into the logistic regression model.
Postoperative pain (Y/N)	399/150	6056/2824	0.029^a a Variables marked with an asterisk were entered into the logistic regression model.
Nightmare (Y/N)	112/437	901/7979	< 0.0001^a a Variables marked with an asterisk were entered into the logistic regression model.
Time taken for postoperative anesthesia consultation clinic (day)	9.2 (8.5)	8.3 (7.1)	0.007^a a Variables marked with an asterisk were entered into the logistic regression model.

Variables	Odds ratio	95% CI	p-value
Age (years)	0.99	0.99-1.001	0.334
Coexisting disease	1.29	1.05-1.59	0.014
ICU admission	1.00	0.74-1.35	0.975
Inhalational anesthesia	0.86	0.68-1.08	0.197
Combination of regional anesthesia	1.44	1.10-1.88	0.007
Difficult airway	1.45	0.84-2.49	0.180
Self-reported awareness	1.98	1.29-3.06	0.002
Memory of extubation	0.98	0.69-1.39	0.896
Dental injury	1.54	0.72-3.32	0.265
PONV	1.54	1.25-1.90	0.0001
Hoarseness	1.15	0.93-1.42	0.186
Sore throat	1.12	0.91-1.38	0.299
Postoperative pain	1.19	0.95-1.49	0.124
Nightmare	1.96	1.52-2.53	< 0.0001
Time taken for postoperative anesthesia consultation clinic(day)	1.01	1.00-1.02	0.026

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] ⁎ Corresponding author. seninoue@naramed-u.ac.jp