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Anesth Analg 1999;89:652
© 1999 International Anesthesia Research Society

ECONOMICS AND HEALTH SYSTEMS RESEARCH

Which Clinical Anesthesia Outcomes Are Important to Avoid? The Perspective of Patients

Alex Macario, MD, MBA*, Matthew Weinger, MD{dagger}, Stacie Carney, BA{ddagger}, and Ann Kim, BA{ddagger}

*Departments of Anesthesia and Health Research and Policy, Stanford University Medical Center, Stanford; {dagger}Department of Anesthesiology, University of California San Diego and the San Diego Veterans Affairs Healthcare System, San Diego; and {ddagger}Stanford University, Stanford, California

Address correspondence to Alex Macario, MD, MBA, Department of Anesthesia (H3580), Stanford University Medical Center, Stanford, CA 94305-5115, Address e-mail to amaca{at}leland.stanford.edu

Healthcare quality can be improved by eliciting patient preferences and customizing care to meet the needs of the patient. The goal of this study was to quantify patients' preferences for postoperative anesthesia outcomes. One hundred one patients in the preoperative clinic completed a written survey. Patients were asked to rank (order) 10 possible postoperative outcomes from their most undesirable to their least undesirable outcome. Each outcome was described in simple language. Patients were also asked to distribute $100 among the 10 outcomes, proportionally more money being allocated to the more undesirable outcomes. The dollar allocations were used to determine the relative value of each outcome. Rankings and relative value scores correlated closely (r2 = 0.69). Patients rated from most undesirable to least undesirable (in order): vomiting, gagging on the tracheal tube, incisional pain, nausea, recall without pain, residual weakness, shivering, sore throat, and somnolence (F-test < 0.01).

Implications: Although there is variability in how patients rated postoperative outcomes, avoiding nausea/vomiting, incisional pain, and gagging on the endotracheal tube was a high priority for most patients. Whether clinicians can improve the quality of anesthesia by designing anesthesia regimens that most closely meet each individual patient's preferences for clinical outcomes deserves further study.




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