Perspectives on pain registries

Early opioid administration and pain-related patient-reported outcomes on the first postoperative day: an analysis of data from 111,693 patients in 392 surgical wards in Germany

ABSTRACT

The risk-benefit ratio of perioperative opioid analgesia is controversial. Few studies have analyzed the effectiveness of opioids in the early postoperative period. To analyze the effectiveness of early opioid administration in this period in a large number of surgeries in routine care, we compared pain-related outcomes between patients treated on wards with different rates of early opioid administration. In this observational study, we analyzed data from 111,693 patients in 392 surgical wards between 2010 and 2022 within the German Quality Improvement in Postoperative Pain Management registry. We defined early opioid administration at the ward-level as the percentage of patients who received at least 1 opioid dose between the end of surgery and data collection on the first postoperative day, including recovery room and ward. To identify different patterns of early opioid administration, we considered these percentages in patients with mild, moderate, and severe pain and applied k-means clustering. We performed mixed regression analyses to assess associations between clusters and patient-reported outcomes on the first postoperative day. At the ward-level, the median percentage of early opioid administration was 79.5% (first-third quartile: 64.5%-92.0%), and 2 clusters of wards were identified. In clusters 1 and 2, an opioid was administered in 58.5% and 89.0% of patients, respectively. Patients in cluster 2 reported better outcomes for pain intensity and pain-related interference but worse outcomes for nausea. However, the effect sizes were small. Patients treated on surgical wards with a higher rate of early opioid administration reported slightly better pain-related outcomes on the first postoperative day.

The Perioperative Pain Management Bundle is Feasible: Findings From the PAIN OUT Registry

OBJECTIVES

The quality of postoperative pain management is often poor. A "bundle," a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a "Perioperative Pain Management Bundle" and whether this would be associated with improved multidimensional pain-related patient-reported outcomes (PROs).

METHODS

"PAIN OUT," a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery. Staff from 10 hospitals in Serbia used this methodology to collect data at baseline. They then implemented the "Perioperative Pain Management Bundle" into the clinical routine and collected another round of data. The bundle consists of 4 treatment elements: (1) a full daily dose of 1 to 2 nonopioid analgesics (eg, paracetamol and/or nonsteroidal anti-inflammatory drugs), (2) at least 1 type of local/regional anesthesia, (3) pain assessment by staff, and (4) offering patients information about pain management. The primary endpoint was a multidimensional pain composite score (PCS), evaluating pain intensity, interference, and side effects that was compared between patients who received the full bundle versus not.

RESULTS

Implementation of the complete bundle was associated with a significant reduction in the PCS ( P < 0.001, small-medium effect size [ES]). When each treatment element was evaluated independently, nonopioid analgesics were associated with a higher PCS (ie, poorer outcome, and negligible ES), and the other elements were associated with a lower PCS (all negligible small ES). Individual PROs were consistently better in patients receiving the full bundle compared with 0 to 3 elements. The PCS was not associated with the surgical discipline.

DISCUSSION

We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. Future work will seek strategies to improve the effect.

An international study to explore the feasibility of collecting standardised outcome data for Complex Regional Pain Syndrome: recommendations for an international clinical research registry

Introduction

Complex Regional Pain Syndrome (CRPS) is a persistent pain condition with low prevalence. Multi-centre collaborative research is needed to attain sufficient sample sizes for meaningful studies. This international observational study: (1) tested the feasibility and acceptability of collecting outcome data using an agreed core measurement set (2) tested and refined an electronic data management system to collect and manage the data.

Methods

Adults with CRPS, meeting the Budapest diagnostic clinical criteria, were recruited to the study from 7 international research centres. After informed consent, a questionnaire comprising the core set outcome measures was completed: on paper at baseline (T1), and at 3 or 6 months (T2) using a paper or e-version. Participants and clinicians provided feedback on the data collection process. Clinicians completed the CRPS severity score at T1 and optionally, at T2. Ethical approval was obtained at each international centre.

Results

Ninety-eight adults were recruited (female n=66; mean age 46.6 years, range 19-89), of whom 32% chose to receive the T2 questionnaire in an electronic format. Fifty-five participants completed both T1 and T2. Eighteen participants and nine clinicians provided feedback on their data collection experience.

Conclusion

This study confirmed the questionnaire core outcome data are feasible and practicable to collect in clinical practice. The electronic data management system provided a robust means of collecting and managing the data across an international population. The findings have informed the final data collection tools and processes which will comprise the first international, clinical research registry and data bank for CRPS.