TABLE 1 - uploaded by Winfried Meissner
Content may be subject to copyright.
Source publication
Acute postoperative pain management is still far from satisfactory despite the availability of high-quality guidelines and advanced pain management techniques.
An outcome-oriented project called QUIPS (Quality Improvement in Postoperative Pain Management) was developed, consisting of standardized data acquisition and an analysis of quality and proc...
Similar publications
To further improve the advantages of minimally invasive surgery, single port laparoscopic techniques continue to be developed. We report our initial experience with single port laparoscopic appendectomy (SPLA) in children and compare its outcomes to those of conventional laparoscopic appendectomy (CLA).
Clinical data were prospectively collected fo...
Introduction:
Acute appendicitis in the setting of midgut malrotation is uncommon. Midgut malrotation commonly presents within the first month of life. A minority remain asymptomatic and may present with concomitant abdominal pathology making diagnosis difficult.
Presentation of case:
This paper reports a rare case of a 73-year-old male diagnose...
Objective
To explore geographic variations in Irish laparoscopic and open appendectomy procedures.
Design
Analysis based on 2014–2017 administrative hospital data from public hospitals.
Setting
Counties of Ireland.
Participants
Irish residents with hospital admissions for an appendectomy as the principal procedure.
Main outcome measures
Age and...
Citations
... Patients were asked about average and maximum pain using the numeric rating scale (NRS). Furthermore, patients completed the Quality Improvement in Postoperative Pain Management (QUIPS) questionnaire on the first POD [18] and the painDETECT ® questionnaire for neuropathic pain on the third POD [19,20]. ...
... QUIPS is an interdisciplinary and multicenter benchmark project that aims to improve acute, postoperative pain management in surgical centers (standardized quality indicators are collected and evaluated). The questions asked in this questionnaire were both yes/no as well as questions that were rated on a scale from 0 (lowest value) to 15 (highest value) [17,18]. ...
Background and Objectives: Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is nevertheless relatively rare, but leads to the loss of a strongly innervated neuronal organ. This study systematically evaluates postoperative pain levels following enucleation of the eye globe. Materials and Methods: This prospective single-center study enrolled twenty-four patients undergoing enucleation of the eye globe. Perioperatively all patients completed (preoperative day, day of surgery, 1st, 2nd, and 3rd day following surgery) standardized questionnaires concerning their pain experience and treatment-related side-effects (internal protocol, QUIPS, painDETECT®). Patients received usual pain therapy in an unstandardized individual manner. Results: Preoperatively, mean average pain intensity of all included patients was 3.29 ± 2.46 (range, 0–8), 3.29 ± 3.24 (range, 0–8) on the day of surgery, 4.67 ± 1.90 (range, 2–10) on day 1, 3.25 ± 1.39 (range, 1–6) on day 2, and 2.71 ± 1.30 (range, 1–6) on day 3 after surgery. Mean maximum pain intensity was 4.71 ± 3.28 (range, 0–10) preoperatively, 4.04 ± 3.78 (range, 0–10) on the day of surgery, 5.75 ± 2.01 (range, 2–10) on day 1, 4.25 ± 1.89 (range, 2–10) on day 2, and 3.88 ± 1.54 (range, 2–8) on day 3 after surgery. Nineteen patients (79.2%) stated that they would have preferred more pain therapy. Conclusions: Patients undergoing eye enucleation report pain sensations in need of intervention in this university hospital. Thus, effective standardized pain treatment concepts are now a high priority to be established in an interdisciplinary manner containing standardized regimens and continuous regional procedures. Awareness of this problem in the medical team should be sharpened through targeted training and information.
... Although significant progress has been made, achieving optimal postoperative pain management has been challenging for healthcare providers for decades (Sinatra 2010, Ahmed & Yasir 2015, van Boekel et al. 2015, Erlenwein et al. 2016, Zaccagnino et al. 2017. Inadequate pain relief is documented to increase morbidity, mortality (Meissner et al. 2008;Torabi Khah et al. 2020), drug consumption, medical treatment costs (Hayes & Gordon 2015, Petti et al. 2018Pozek et al. 2018), the number of hospital readmissions, and the associated costs of reduced capacity to work (Pozek et al. 2018;Torabi Khah et al. 2020), while it is also detrimental to patient safety and decreases patient satisfaction (Torabi Khah et al. 2020). ...
Background
Postoperative pain management is an important part of surgical care, where Acute Pain Service offers added value in terms of patient outcomes and costs. The technology, however, has hardly been adopted in Hungary, with only two hospitals operating Acute Pain Service and whose performance has not been evaluated yet. This research compared pain management outcomes of surgical, orthopedic, and traumatology patients in Hungarian hospitals with and without Acute Pain Service.
Methods
We recruited 348 patients, 120 in the APS group and 228 in the control group, whose experience was surveyed with an adapted version of the American Pain Society Patient Outcome Questionnaire. The questionnaire covered pain intensity, pain interference with physical and emotional functions, side effects, patient satisfaction, information received, and participation in treatment decisions. The differences were analyzed by Fisher’s exact test and Mann–Whitney U test.
Results
The APS group showed better results with lower pain intensity scores regarding worst postoperative pain (χ² = 18.919, p = 0.0043). They reported less pain interference with activities in bed (χ² = 21.978, p = 0.0006) and out of bed (χ² = 14.341, p = 0.0129). Furthermore, patients in the APS group experienced fewer pain-management-related side effects, like nausea (χ² = 15.240, p = 0.0101), drowsiness (χ² = 26.965, p = 0.0001), and dizziness (χ² = 13.980, p = 0.0124). However, patient information (χ² = 3.480, p = 0.0945) and patient satisfaction (χ² = 5.781, p = 0.2127) did not differ significantly between the two groups.
Conclusions
Our findings confirm earlier international evidence on the benefits of Acute Pain Service in postoperative pain management and support the wider adoption of the technology in Hungarian hospitals. Nevertheless, close attention should be paid to patient information and involvement as better outcomes alone do not necessarily increase patient satisfaction.
... To ensure sufficient inclusion numbers, we advertised participation in our study throughout Europe, using a network of former study sites and the webpage of the well established projects PAIN OUT and QUIPS. 9,10 If the estimated number of procedures of interest and potential patient recruitment were sufficient, conclusion of a cooperation-agreement was the next step. This co-operation agreement ensured adherence to the standard operating procedure, confidentiality, data exploitation rules, and regulated the remuneration. ...
BACKGROUND
Chronic postsurgical pain (CPSP) is a clinical problem, and large prospective studies are needed to determine its incidence, characteristics, and risk factors.
OBJECTIVE
To find predictive factors for CPSP in an international survey
DESIGN
Observational study
SETTING
Multicentre European prospective observational trial
PATIENTS
Patients undergoing breast cancer surgery, sternotomy, endometriosis surgery, or total knee arthroplasty (TKA).
METHOD
Standardised questionnaires were completed by the patients at 1, 3, and 7 days, and at 1, 3, and 6 months after surgery, with follow-up via E-mail, telephone, or interview.
MAIN OUTCOME MEASURE
The primary goal of NIT-1 was to propose a scoring system to predict those patient likely to have CPSP at 6 months after surgery.
RESULTS
A total of 3297 patients were included from 18 hospitals across Europe and 2494 patients were followed-up for 6 months. The mean incidence of CPSP at 6 months was 10.5%, with variations depending on the type of surgery: sternotomy 6.9%, breast surgery 7.4%, TKA 12.9%, endometriosis 16.2%. At 6 months, neuropathic characteristics were frequent for all types of surgery: sternotomy 33.3%, breast surgery 67.6%, TKA 42.4%, endometriosis 41.4%. One-third of patients experienced CPSP at both 3 and 6 months. Pre-operative pain was frequent for TKA (leg pain) and endometriosis (abdomen) and its frequency and intensity were reduced after surgery. Severe CPSP and a neuropathic pain component decreased psychological and functional wellbeing as well as quality of life. No overarching CPSP risk factors were identified.
CONCLUSION
Unfortunately, our findings do not offer a new CPSP predictive score. However, we present reliable new data on the incidence, characteristics, and consequences of CPSP from a large European survey. Interesting new data on the time course of CPSP, its neuropathic pain component, and CPSP after endometriosis surgery generate new hypotheses but need to be confirmed by further research.
TRIAL REGISTRATION
clinicaltrials.gov ID: NCT03834922
... One of the goals of QUIPS is self-reflection on the standard procedures of the departments. Additionally, this allows for a comparison between different hospitals through benchmarking, and therefore offers an opportunity to improve pain management, if necessary [29]. To this end, a validated questionnaire was completed by each patient after CS on the first postoperative day 24-32 h after surgery. ...
... Clinical as well as demographic data were registered simultaneously and transmitted to the QUIPS online database [29]. Eligible patients had to fulfill the following conditions for inclusion: age above 18, answering the questionnaire on the first postsurgical day after CS and informed written consent. ...
Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry “quality improvement in postoperative pain treatment” (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS ≥ 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p < 0.001). Distraction, relaxation, mobilization, having conversations, patient-controlled analgesia (PCA) and pain monitoring were shown to be protective for severe pain (p < 0.001). Maximal pain in PCS and UCS was similar, but UCS obtained more analgesics (p < 0.001), and experienced more impairment of ambulation (p < 0.001) and deep breathing (p < 0.05). Severe pain has a major effect on daily-life activities and recovery after CS, and depends on modifiable factors. More effort is needed to improve the quality of care after CS.
... The QUIPS project demonstrates a major nationwide German initiative, which records and benchmarks postoperative pain [15]. Featuring more than 200 participating hospitals with data sets from more than 600,000 patients, the QUIPS project represents the worldwide largest database for postoperative pain [17]. The concept incorporates the whole health care team and empowers the role of the nurses who see the patients most frequently and therefore represent the main medical contact person. ...
Background:
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.
Materials and methods:
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.
Results:
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 p < 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 (p < 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.
Conclusion:
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.
... As part of the routine care in our institution, all participants received the "QUIPS-Geburt" questionnaire of the benchmarking project QUIPS (Quality-Improvement-in-Postoperative-Pain-Management) 24-48 h following delivery. This patient-reported outcome questionnaire assesses patient pain perception and pain treatment following operative interventions and has recently been validated to record pain encountered during vaginal delivery [20,21] (Link: https:// www. quips-proje kt. ...
Purpose
Safe and effective analgesia sub partu is one of the central issues in optimizing vaginal delivery birth experiences. Meptazinol is a common opiate approved for treating labor pain in the first stage of labor. According to the manufacturer, manual meptazinol can be applied intramuscularly or intravenously. The aim of this study was to compare the two application methods in terms of efficacy in pain relief, occurrence of side effects and treatment satisfaction.
Methods
132 patients with singleton term pregnancies and intended vaginal delivery, receiving meptazinol during first stage of labor were included in this prospective cohort study from 05/2020 to 01/2021. We evaluated effectiveness in pain relief and treatment satisfaction using numeric rating scales (NRS) and documented the occurrence of adverse effects. Chi-square test or Fisher exact test were used to compare categorical data and Mann–Whitney U test to compare continuous data between the two treatment groups. Statistical analysis was done by SPSS 27.0. A p value < 0.05 was considered to indicate statistical significance (two tailed).
Results
Meptazinol decreased labor pain significantly from a NRS of 8 (IQR 8–10) to 6 (IQR 4.75–8) in both treatment groups with no difference in effectiveness between the groups. Frequency of effective pain reduction of a decrease of 2 or more on the NRS did not differ between groups (39.4% vs 54.5%, p = 0.116), as the occurrence of adverse effects. 12% of the newborns were admitted to NICU, the median NApH was 7.195.
Conclusion
Meptazinol significantly reduces labor pain regardless of the method of application: intramuscular or intravenous. According to our data, no preferable route could be identified. The comparably poorer perinatal outcome in our study cohort hinders us to confirm that meptazinol is safe and can be recommended without restrictions.
... Including data sets from over 600.000 patients and over 200 participating hospitals, it demonstrates the largest database for acute postoperative pain worldwide. The project is supported by the German Society of Anesthesiologist and the German Society of Surgeons [29]. All data were anonymized. ...
Introduction
Enhanced recovery after surgery (ERAS) leads to less morbidity, faster recovery, and, therefore, shorter hospital stays. The expected increment of primary total hip arthroplasty (THA) in the U.S. highlights the need for sufficient pain management. The favorable use of short-lasting spinal anesthesia enables early mobilization but may lead to increased opioid consumption the first 24 h (h) postoperatively.
Methods
In a retrospective study design, we compared conventional THA with postoperative immobilization for two days (non-ERAS) and enhanced recovery THA with early mobilization (ERAS group). Data assessment took place as part of the “Quality Improvement in Postoperative Pain Treatment project” (QUIPS). Initially, 2161 patients were enrolled, resulting in 630 after performing a matched pair analysis for sex, age, ASA score (American-Society-of-Anesthesiology) and preoperative pain score. Patient-reported pain scores, objectified by a numerical rating scale (NRS), opioid consumption and side effects were evaluated 24 h postoperatively.
Results
The ERAS group revealed higher activity-related pain (p = 0.002), accompanied by significantly higher opioid consumption (p < 0.001). Maximum and minimum pain as well as side effects did not show significant differences (p > 0.05).
Conclusion
This study is the first to analyze pain scores, opioid consumption, and side effects in a matched pair analyses at this early stage and supports the implementation of an ERAS concept for THA. Taking into consideration the early postoperative mobilization, we were not able to detect a difference regarding postoperative pain. Although opioid consumption appeared to be higher in ERAS group, occurrence of side effects ranged among comparable percentages.
... In the 1990s, benchmarking was utilized as a method to measure and compare outcomes across organizations in the healthcare system [4,42,43] . It also underwent several modifications in the healthcare system [44] . Initially, the benchmarking focused on the comparison of performance outcomes to identify gaps [4,42,44] . ...
... It also underwent several modifications in the healthcare system [44] . Initially, the benchmarking focused on the comparison of performance outcomes to identify gaps [4,42,44] . Benchmarking was defined as a measuring tool for assessing the impact of management, governance, and logistical and clinical functions [4,45] . ...
... Benchmarking was defined as a measuring tool for assessing the impact of management, governance, and logistical and clinical functions [4,45] . Subsequently, the benchmarking expanded to include consideration of process and important factors leading to achieving superior performance [44,46,47] . Then, the benchmarking was developed to pursue the best practices for meeting patients' expectations [4,47] . ...
Introduction:
Benchmarking, a novel measuring tool for outcome comparisons, is a recent concept in surgery. The objectives of this review are to examine the concept, definition, and evolution of benchmarking and its application in surgery.
Methods:
The literature about benchmarking was reviewed through an ever-narrowing search strategy, commencing from the concept, definition, and evolution of benchmarking to the application of benchmarking and experiences of benchmarking in surgery. PubMed, Web of Science, Embase, and Science Direct databases were searched until 20 September 2022, in the English language according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.
Results:
In the first phase of the literature search, the development of benchmarking was identified. The definitions of benchmarking evolved from a surveying term to a novel quality-improvement tool to assess the best achievable results in surgery. In the second phase, a total of 23 studies were identified about benchmarking in surgery, including esophagectomy, hepatic surgery, pancreatic surgery, rectum resection, and bariatric surgery. All studies were multicenter analyses from national, international, or global expert centers. Most studies (87.0%) adopted the definition that benchmark was the 75th percentile of the median values of centers. Performance metrics to define benchmarks were clinically relevant intraoperative and postoperative outcome indicators.
Conclusion:
Benchmarking in surgery is a novel quality-improvement tool to define and measure the best achievable results, establishing a meaningful reference to evaluate surgical performance.
... Postoperative pain detrimentally affects the quality of life of patients ( Fang et al., 2017 ), by, for example, reducing their mobility, which in turn has an adverse effect on respiration, decreases the oxygenation of the body, and may result in pneumonia ( Hayes & Gordon, 2015 ;Park et al., 2020 ;Petti et al., 2018 ). Further problems may arise from the treatment of pain, or its lack thereof, such as the common side effects of nausea, tiredness, and drowsiness ( Meissner et al., 2008 ), or chronic postoperative pain, which can be the result of inadequately managed pain ( Meissner et al., 2008 ;Park et al., 2020 ;Pozek et al., 2018 ). In addition to its health effects, inadequate pain management also increases costs, for instance by longer length of stay and the high costs of treating complications ( Hayes & Gordon, 2015 ;Meissner et al., 2008 ;Petti et al., 2018 ;Pozek et al., 2018 ;Torabi Khah et al., 2020 ). ...
... Postoperative pain detrimentally affects the quality of life of patients ( Fang et al., 2017 ), by, for example, reducing their mobility, which in turn has an adverse effect on respiration, decreases the oxygenation of the body, and may result in pneumonia ( Hayes & Gordon, 2015 ;Park et al., 2020 ;Petti et al., 2018 ). Further problems may arise from the treatment of pain, or its lack thereof, such as the common side effects of nausea, tiredness, and drowsiness ( Meissner et al., 2008 ), or chronic postoperative pain, which can be the result of inadequately managed pain ( Meissner et al., 2008 ;Park et al., 2020 ;Pozek et al., 2018 ). In addition to its health effects, inadequate pain management also increases costs, for instance by longer length of stay and the high costs of treating complications ( Hayes & Gordon, 2015 ;Meissner et al., 2008 ;Petti et al., 2018 ;Pozek et al., 2018 ;Torabi Khah et al., 2020 ). ...
... Further problems may arise from the treatment of pain, or its lack thereof, such as the common side effects of nausea, tiredness, and drowsiness ( Meissner et al., 2008 ), or chronic postoperative pain, which can be the result of inadequately managed pain ( Meissner et al., 2008 ;Park et al., 2020 ;Pozek et al., 2018 ). In addition to its health effects, inadequate pain management also increases costs, for instance by longer length of stay and the high costs of treating complications ( Hayes & Gordon, 2015 ;Meissner et al., 2008 ;Petti et al., 2018 ;Pozek et al., 2018 ;Torabi Khah et al., 2020 ). ...
Background
Pain management is a key issue in health care. Providers adopt promising technological developments, like Acute Pain Service, at differing speeds, with countries, such as the USA and Germany taking the lead. Where Hungary stands is unknown, as the practice of pain management has not yet been comprehensively reviewed in that country.
Aim
To explore the practice of postoperative pain management in Hungarian hospitals by addressing the questions of who is responsible for it, who measures pain and how, what kind of pain relief technologies are used, and who takes care of patients during duty hours.
Methods
We carried out a survey covering Hungarian hospitals with operational license for surgery, traumatology, orthopedics and anesthesiology between December 2019 and March 2020. The response rate was 72%, and we analyzed 135 questionnaires.
Results
We identified only 2 hospitals with an Acute Pain Service. In the majority of hospitals, the attending physician orders pain relief therapy. During duty hours the surgeon on duty takes care of pain management in 52.1% of the cases. Among pain relief therapies, intravenous infusions (74.1%) and oral medication (67.4%) are the most frequent. Ward nurses measure postoperative pain (77.8%) with unidimensional scales. According to 59.7% of the respondents, pain is not measured and documented at rest. Written protocols are available in 34.4% of the departments.
Conclusions
Compared with other countries, pain management in Hungary lags behind with significant room for improvement. Development and implementation of pain management protocols with appropriate education is the key intervention point.
... Strengths and limitations associated with this study PAIN OUT is one of two active multi-centre perioperative pain registries known to us. QUIPS facilitates data collection within Germany (Meissner et al., 2008), whereas, PAIN OUT is international. A registry has a more or less fixed set of measures, allowing for standardized data collection in different settings. ...
Background:
Postoperative pain is common at the global level, despite considerable attempts for improvement, reflecting the complexity of offering effective pain relief. In this study, clinicians from Mexico, China, and eight European countries evaluated perioperative pain practices and patient-reported outcomes (PROs) in their hospitals as a basis for carrying out quality improvement (QI) projects in each country.
Methods:
PAIN OUT, an international perioperative pain registry, provided standardized methodology for assessing management and multi-dimensional PROs on the first postoperative day, in patients undergoing orthopedic, general surgery, obstetric & gynecology or urological procedures.
Results:
Between 2017-2019, data obtained from 10,415 adult patients in 105 wards, qualified for analysis. At the ward level: 50% (median) of patients reported worst pain intensities ≥7/10 NRS, 25% spent ≥50% of the time in severe pain and 20-34% reported severe ratings for pain-related functional and emotional interference. Demographic variables, country and surgical discipline explained a small proportion of the variation in the PROs, leaving about 88% unexplained. Most treatment processes varied considerably between wards. Ward effects accounted for about 7% and 32% of variation in PROs and treatment processes, respectively.
Conclusions:
This comprehensive evaluation demonstrates that many patients in this international cohort reported poor pain-related PROs on the first postoperative day. PROs and treatments varied greatly. Most of the variance of the PROs could not be explained. The findings served as a basis for devising and implementing QI programs in participating hospitals.
