The influence of postoperative environment on patient pain and satisfaction: a randomized trial.

Abstract Background Improving the patient experience, controlling pain with non-opiate therapies, and preparing for value based reimbursement are increasingly important foci for both physicians and hospitals. Objectives We sought to determine if the addition of music and a natural landscape image to postoperative hospital rooms would result in improved pain and satisfaction scores among inpatients undergoing pelvic reconstructive surgery. Study Design This was an Institutional Review Board approved, randomized controlled trial. Eligible candidates were 18-85 years old, English speaking, and scheduled to undergo native tissue vaginal vault suspension for symptomatic pelvic organ prolapse. Exclusions included history of a chronic pain or substance abuse. Subjects were advised the purpose of the study was to assess the impact of changes to the hospital environment on patient experience, but were blinded to their group and intervention details. Changes included a landscape image mounted to the wall, as well as access to a speaker with preprogrammed music selections. The intervention group was instructed to listen to their preferred music for a minimum of two 30-minute sessions postoperatively. The control group had a standard hospital room, without music or landscape. All patient rooms were private. The primary outcome was the Visual Analogue Scale (VAS) for pain on the morning of post-operative day one. Secondary outcomes included narcotic use, likelihood to refer family to the same hospital facility, satisfaction with care and the hospital, and perception of a healing environment. A sample size of 43 subjects per arm was calculated in order to detect a difference of 10mm in VAS pain score. Results One hundred thirty-three subjects were enrolled; primary outcome data was available for 92 (46 per arm). The mean age was 63.8 (SD 9.5) years, median Charlson Comorbidity score was 2 (min=0,max=7), and 94.6% were Caucasian. On postoperative day one, median VAS scores for pain were low (28.8mm (0,86), 24.5mm (0,81)), and did not differ between intervention and control, respectively (p=0.57). Total morphine equivalents (p=0.817) and nursing pain scores (p=0.774) were also similar. However, the intervention group displayed a higher likelihood to refer family members to the hospital (98mm(47, 100), 96mm(65, 100), p=0.037). At 2 weeks postoperative, the intervention group demonstrated higher satisfaction with their care (98mm (34, 100), 95mm (42, 100), p=0.032), the hospital (98mm (71, 100), 94mm (6, 100), p=0.004), and the healing environment provided during their stay (98mm (52, 100), 92mm (19, 100), p=0.020), than those in standard hospital rooms. Conclusion In this randomized trial, we demonstrated music and landscape imagery did not significantly impact post-operative pain scores, however they had a positive impact on the postoperative experience. Further, this impact appeared to broaden two weeks following surgery. Given the importance of value-based care, interventions such as these should be emphasized in an effort to enhance patient satisfaction, quality scores and overall well-being.