Patient satisfaction with postoperative analgesia after hepatobiliary and pancreatic surgery: a retrospective analysis.

OBJECTIVES: Patient satisfaction is a key metric for evaluating healthcare quality. Patients undergoing hepatobiliary and pancreatic surgery frequently experience severe postoperative pain, necessitating patient-controlled intravenous analgesia (PCIA). This study aimed to identify factors associated with reduced satisfaction regarding PCIA in this context. METHODS: A retrospective observational study analyzed data from adults receiving PCIA after elective hepatobiliary and pancreatic surgery. Univariate and multivariate logistic regression, employing a forced-entry method to adjust for a comprehensive panel of clinically relevant confounders [including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) status, surgical trauma category, surgical approach, malignancy, and major postoperative complications], were used to examine associations between satisfaction and demographics, surgical details, analgesic regimens, postoperative pain (NRS), and adverse effects. RESULTS: Among 1,667 patients, 108 (6.5%) were dissatisfied. Multivariable analysis identified moderate-to-severe pain (NRS > 3; aOR = 14.93, 95%CI: 9.52-26.32) and hyperhidrosis (aOR = 6.29, 95% CI: 3.05-13.89) as strong independent predictors of dissatisfaction (both P < 0.001). A significant interaction was found between dezocine and pain severity (P < 0.001). Among patients with NRS > 3, dezocine was associated with significantly lower odds of dissatisfaction (aOR = 0.18, 95% CI: 0.06-0.55), corresponding to an ∼87% reduction, whereas no significant benefit was observed in those with mild pain (aOR = 1.22, 95% CI: 0.33-4.68, P = 0.771). Hyperhidrosis was independently associated with rescue analgesia (OR = 8.82, P = 0.016). CONCLUSIONS: Dissatisfaction is driven by moderate-to-severe pain and hyperhidrosis. The benefit of dezocine is context-dependent. Optimizing satisfaction requires managing pain, autonomic side effects, and personalized analgesic selection.