Benchmarking to Address Total Hip Arthroplasty-Related Pain?

A recent prospective cohort study involving patients who underwent total hip arthroplasty at Jena University Hospital, Jena, Germany demonstrated that a standardized process for data analysis and internal benchmarking facilitated a reduction in postoperative pain and improvements in patient satisfaction. The study, led by Achim Benditz MD of University Medical Center Regensburg, was published December 16 in the Journal of Pain Research.¹

In an analysis of procedure-specific risk factors for severe postoperative pain, total hip arthroscopy was rated as the eleventh most painful procedure.² However, according to the authors, not all of the contributors to pain are medical in nature. “We believe that inadequate pain treatment is often caused by organizational problems and lack of sufficient staff education in pain issues,” they wrote.

The study population of 367 patients consisted of all patients at the hospital who underwent total hip arthroscopy from 2014 to 2015, and who had the ability to communicate. Patients not present at the time of data collection, patients who had visitors at the time of data collection, patients who refused to participate in the study, and patients who were sedated, asleep or had cognitive dysfunction, were excluded. The questionnaires used were created for the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS), and consisted of 15 questions on pain intensity, functional impairment, side effects of pain treatment, and global assessment as reported by the patient.³ Additionally, a random sampling of patients was interviewed by a pain nurse on the first postoperative day. All study participants received a standardized anesthesia and postoperative pain management regimen.

Results for the 2 year study showed that the mean maximal pain score 24 hours post-surgery dropped from a baseline of 4.0 (±3.0) on an 11-point numeric rating scale, to 3.0 (±2.0). Patient satisfaction increased from 9.0 (±1.2) to 9.8 (±0.4; P <.05).

In an interview with Clinical Pain Advisor, Dr Benditz emphasized that the use of a standardized pain questionnaire as part of everyday clinical practice allows clinicians to detect problems early. He added that in his department’s most recent meeting, his team noted a change in the rate of patients with nausea after surgery. “We immediately started to analyze all patients affected and now try to find out where the problem is. Without this kind of benchmarking we wouldn’t even know.”

Dr Benditz offered advice to clinicians considering instituting a similar benchmarking program:“If you have an existing pain management concept, which in your opinion is technically up-to-date and sound, benchmarking can even improve the postoperative pain management, and then using it in a daily routine,  it can detect any problems occurring very early. When you want to start, you can start to compare the wards of the own hospitals with each other.” 

The authors declared no conflicts of interest.

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References

1. Benditz A, Greimel F, Auer P, et al. Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients. J Pain Res. 2016;9:1205-1213. doi:10.2147/JPR.S124379.
2. Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237-1245. doi:10.1097/ALN.0000000000000108.
3. Meissner W, Mescha S, Rothaug J, et al. Quality Improvement in Postoperative Pain Management. Dtsch Ärztebl Int. 2008;105(50):865-870. doi:10.3238/arztebl.2008.0865.