Reinhard Jan, Pulido Loreto C, Schindler Melanie, Schraag Amadeus, Greimel Felix, Grifka Joachim, Benditz Achim
Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany.
J Clin Med. 2023 Jul 10;12(14):4577. doi: 10.3390/jcm12144577.
Total hip arthroplasty (THA) is still ranked among the operations with the highest postoperative pain scores. Uncontrolled postsurgical pain leads to prolongated hospital stays, causes more frequent adverse reactions and can induce chronical pain syndromes. In 2014, we implemented a standardized, multidisciplinary pain management concept with continuous benchmarking at our tertiary referral center by using the "Quality Improvement in Postoperative Pain Management" (QUIPS) program with excellent results over a period of two years. The initial study ended in 2016 and we aimed to evaluate if it was possible to obtain the excellent short-term results over a period of six years without any extra effort within the daily clinical routine.
In a retrospective study design, we compared postoperative pain, side effects and functional outcome after primary THA for 2015 and 2021, using validated questionnaires from the QUIPS project. In contrast to the implementation of the pain management concept in 2014, the weekly meetings of the multidisciplinary health care team and special education for nurses were stopped in 2021. Data assessment was performed by an independent pain nurse who was not involved in pain management.
Altogether, 491 patients received primary THA in 2015 and 2021 at our tertiary referral center. Collected data revealed significantly worse maximum and activity-related pain (both < 0.001) in combination with significantly higher opioid consumption in comparison to implementation in 2015. Though the patients reported to be less involved in pain management ( < 0.001), the worse pain scores were not reflected by patient satisfaction which remained high. While the participation rate in this benchmarking program dropped, we still fell behind in terms of maximum and activity-related pain in comparison to 24 clinics.
Significantly worse pain scores in combination with higher opioid usage and a lower hospital participation rate resemble a reduced awareness in postoperative pain management. The significantly lower patient participation in pain management is in line with the worse pain scores and indirectly highlights the need for special education in pain management. The fact patient satisfaction appeared to remain high and did not differ significantly from 2015, as well as the fact we still achieved an acceptable ranking in comparison to other clinics, highlight the value of the implemented multidisciplinary pain management concept.
全髋关节置换术（THA）仍是术后疼痛评分最高的手术之一。术后疼痛控制不佳会导致住院时间延长，引发更频繁的不良反应，并可能诱发慢性疼痛综合征。2014年，我们在三级转诊中心实施了标准化的多学科疼痛管理理念，并通过“术后疼痛管理质量改进”（QUIPS）计划持续进行基准评估，在两年内取得了优异的成果。初步研究于2016年结束，我们旨在评估在日常临床工作中不做任何额外努力的情况下，是否有可能在六年内获得优异的短期效果。
在一项回顾性研究设计中，我们使用QUIPS项目的有效问卷，比较了2015年和2021年初次全髋关节置换术后的疼痛、副作用和功能结果。与2014年实施疼痛管理理念不同，2021年多学科医疗团队的周会和护士的专项培训停止了。数据评估由一名未参与疼痛管理的独立疼痛护士进行。
2015年和2021年，共有491例患者在我们的三级转诊中心接受了初次全髋关节置换术。收集的数据显示，与2015年实施时相比，最大疼痛和活动相关疼痛显著更严重（均P<0.001），同时阿片类药物消耗量显著更高。尽管患者报告参与疼痛管理的程度较低（P<0.001），但较差的疼痛评分并未反映在患者满意度上，患者满意度仍然很高。虽然该基准评估项目的参与率下降，但与24家诊所相比，我们在最大疼痛和活动相关疼痛方面仍落后。
显著更差的疼痛评分、更高的阿片类药物使用量和更低的医院参与率表明术后疼痛管理意识降低。患者参与疼痛管理的程度显著降低与更差的疼痛评分一致，间接凸显了疼痛管理专项培训的必要性。患者满意度似乎仍然很高，与2015年相比没有显著差异，以及与其他诊所相比我们仍取得了可接受的排名这一事实，凸显了所实施的多学科疼痛管理理念的价值。
