[Costs of patient controlled analgesia in postoperative pain management in Germany]

[Standardized treatment protocols in acute postoperative pain therapy: analysis of contents of standardized medicinal concepts]

BACKGROUND

Standardized treatment approaches can improve the quality of the management of acute postoperative pain.

AIM

The purpose of this study was to describe the content and structure of currently implemented standards for the management of acute postoperative pain in German hospitals and to better define the concept of a treatment standard for acute pain.

MATERIAL AND METHODS

Written standardized treatment protocols from 68 hospitals for the management of acute postoperative pain were analyzed. The evaluation was based on the layout of processes, the baseline and rescue or on-demand analgesic medication and safety mechanisms.

RESULTS

A treatment standard per hospital separated for adults (68 standards) and children (27 standards) was identified and analyzed. A baseline medication was provided in all standards for adults and in 89% for children. Of the 95 standards 68% routinely combined opioids and non-opioids as a basis (78% for adults and 42% for children). A way to adapt the baseline medication was described more often in standards for adults. Of the standards for adults 91% (85% for children) contained provisions for rescue or on-demand analgesia and half of them (both adults and children) included an immediate-release opioid formulation, which was readily available. For adults the availability was regulated by a predefined process in 29% of the standards (8% for children). In cases of persisting pain, repetition of the rescue medication was generally possible in 63% of adult standards (54% for children) but within 1 h after the first dose in only 43% (30% for children). Intervention limitations for application of the rescue medication (e.g., a defined score on the numeric rating scale) were set in 63% of adult standards (54% for children). A follow-up assessment of the pain intensity after a rescue medication was only required in approximately half of the standards and safety information or mechanisms were only rarely included.

CONCLUSION

Content, structure and type of the evaluated treatment standards showed a considerable heterogeneity with respect to the availability of rescue and baseline medication. Safety aspects were not addressed in many cases. These findings show that despite the requirements of the German guidelines for treatment of perioperative and posttraumatic pain for treatment standards, there are still no practical recommendations with respect to contents and structure of such standards.

[What is the difference between patients with and without complex postoperative acute pain therapy?: An analysis of medical and economic characteristics]

BACKGROUND

Appropriate postoperative pain therapy is essential for an accelerated recovery. However, coding complex acute pain therapy (OPS 8-919) does not have any impact on hospital revenues. As medical and economic primary data related to this therapy are scarce, hospital data were analysed to identify differences between patients with and without acute pain therapy.

MATERIAL AND METHODS

Two patient groups were generated out of an anonymized data set from 372 acute care hospitals in 2005: The case group (G1) included 4,197 patients (OPS 8-919 coded). The control group (G2) contained 61,181 patients (neither OPS 8-919 nor 8-910 nor 8-911 coded).

RESULTS

The analysis revealed that patients in G1 had a prolonged mean length of hospital stay (2.5 days). The mean number of diagnoses per case was similar in both groups (G1:6.9, G2:6.6), whereas the mean number of procedures was higher in G1 (G1:8.2, G2:6.2). The difference in mean diagnosis-related group (DRG) revenue per case was about EUR 200 (G1:EUR 9,233, G2:EUR 9,030).

CONCLUSION

To validate the results found in this analysis, further evaluations of these patient groups are essential. High-quality documentation and coding in hospitals are required for future studies.