A Retrospective Analysis of Length of Stay in Postoperative Fracture Repair Patients Receiving Patient-Controlled Analgesia Versus Nurse-Administered Analgesia

Abstract

Background: Patient-controlled analgesia (PCA) is a widely used method for managing postoperative pain. However, its impact on hospital length of stay (LOS) is unclear due to patient population variation. Currently, there is limited data directly comparing LOS in limb fracture patients receiving PCA versus those exclusively receiving nurse-administered analgesia (NAA). Objectives: To assess the impact of PCA in combination with NAA on hospital LOS and postoperative pain scores in limb fracture surgery patients compared to NAA alone. Methods: A retrospective chart review was conducted to examine the LOS between all postoperative Northeast Georgia Health System (NGHS) patients between 18 and 75 years of age who underwent surgical limb fracture repairs between 2019 and 2024, specifically evaluating those who exclusively received NAA versus those who received a combination of PCA and NAA. The PCA and NAA groups each consisted of 49 patients. The PCA group self-administered intravenous (IV), epidural, or peripheral nerve analgesics via PCA pumps in addition to receiving nurse-administered transdermal or intramuscular analgesics. The NAA group received transdermal, intramuscular, or IV analgesics exclusively via manual administration by nursing staff. Medications included in this study were morphine, oxycodone, hydromorphone, fentanyl, and acetaminophen. Measured outcome variables include hospital LOS and pre- and postoperative pain scores, which were directly taken from NGHS’s electronic medical record. Results: The two groups studied included patients who received IV PCA in addition to NAA (termed as PCA) and patients who exclusively received transdermal, intramuscular, and/or IV NAA (termed as non-PCA). A total of n = 49 patients underwent limb fracture repair and received PCA, and 49 patients from the non-PCA group were matched accordingly. After propensity matching, average preoperative pain scores between the non-PCA and PCA groups were similar at 5.64 and 5.60, respectively. Patients in the PCA group had higher mean postoperative pain scores (μ = 4.92) compared to the NAA group (μ = 4.41), with a mean difference of 0.51 points (P = 0.046). Conclusions: This retrospective analysis suggests that the use of PCA in conjunction with NAA is associated with increased LOS and higher postoperative pain scores when compared to NAA alone in patients undergoing surgical repair of limb fractures.