The Quality of Postoperative Pain Therapy in German Hospitals

Abstract

Background: Many patients in German hospitals complain of inadequate treatment of their postoperative pain. Hospital-related structural and procedural variables may affect pain perception and patient satisfaction. We studied the association of individual variables with outcome quality.

Methods: Data from the years 2011 to 2014 from the world's largest acute pain registry (QUIPS) were evaluated. The analysis was performed with mixed linear regression models.

Results: We studied registry data from 138 German hospitals concerning four commonly performed types of operations (total number of operations, 21 114) and found that the intensity of pain, functional impairment, and satisfaction with postoperative pain therapy were all highly variable from one hospital to another. Patients in university hospitals complained more often than those in standard care facilities of highly intense pain (odds ratio [OR] 2.44; 95% con - fidence interval [CI] [1.18; 5.04]) and dissatisfaction (OR 3.58 [1.85; 6.93]). In specialized centers as well, pain intensity (OR 1.39 [1.06; 1.83]) and dissatisfaction (OR 1.59 [1.25; 2.02]) were higher. Pain-related limitation of movement was also reported more commonly in university hospitals (OR 2.12 [0.87; 5.16]) and specialized centers (OR 1.87 [1.33; 2.65]) than in standard care facilities. Less pain-related limitation of movement and higher satisfaction were reported in hospitals in which pain was documented in the patients' charts and the patients felt adequately informed about the treatment options.

Conclusion: The current state of postoperative pain therapy leaves much room for improvement. Quality indicators in the field of acute pain medicine might help improve patient care.

Figure 1

Distribution of mean responses for maximum pain intensity per hospital for the four operations analyzed in 103 hospitals with at least 20 data sets. The horizontal lines represent quartiles 1 to 3. Lap., laparoscopic

eFigure 1

Distribution of mean responses for pain-related restriction of movement [yes/no] expressed as percentage of “yes” responses per hospital for the four operations analyzed (laparoscopic cholecystectomy, herniotomy, hip joint replacement, and knee joint replacement) in 103 hospitals with at least 20 data sets. The horizontal lines represent quartiles 1 to 3

eFigure 2

Distribution of mean responses for satisfaction with postoperative pain therapy [0 = completely dissatisfied; 15 = absolutely satisfied] per hospital for the four operations analyzed (laparoscopic cholecystectomy, herniotomy, hip joint replacement, and knee joint replacement) in 103 hospitals with at least 20 data sets. The horizontal lines represent quartiles 1 to 3

eFigure 3

Distribution of mean responses for the three dichotomized variables of outcome quality for the four operations analyzed. Each dot represents the percentage of patients for a specific hospital (N = 103). The horizontal lines represent quartiles 1 to 3. a) Proportion with pain rated >4 on the NRS b) Proportion who feel restricted in their movements c) Proportion who report lower satisfaction

eFigure 4

Uni- and bivariate distribution of mean responses for the three untransformed parameters of outcome quality from the patient’s perspective for the four operations analyzed. Each dot summarizes one hospital (N = 103); the univariate distributions (expressed as estimated density distributions) are shown along the diagonals