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Analgesic use and favourable patient-reported outcome measures after paediatric surgery: an analysis of registry data
Kyra Bernhart1, Karin Becke-Jakob2, Thomas Lehmann3
1Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Post-surgical pain in children is often undertreated. Optimizing analgesic dosing, including non-opioid analgesics and dexamethasone, can improve pain management and patient outcomes after paediatric surgery.
Area of Science:
- Pediatric Surgery
- Pain Management
- Clinical Outcomes
Background:
- Post-operative pain following appendectomy and tonsillectomy in children is frequently undertreated.
- Hospital benchmarking can identify effective strategies for improving patient- and parent-reported pain outcomes.
Purpose of the Study:
- To benchmark European hospitals based on patient-reported outcomes (PROs) 24 hours after paediatric surgery.
- To identify process variables, such as analgesic dosing, associated with favorable pain management outcomes.
Main Methods:
- Analysis of 898 anonymized cases from 11 European hospitals.
- Hospitals categorized into favorable (Group I), average (Group II), and unfavorable (Group III) based on composite PRO measures.
- Multinomial regression used to analyze associations between process variables (analgesic dosing, dexamethasone) and PRO scores.
Main Results:
- Group I hospitals administered more non-opioid analgesics (1.2 doses) compared to Group III (0.7 doses).
- Intraoperative dexamethasone use was higher in Group I (70.1%) versus Group III (52.6%).
- Lower non-opioid analgesic doses, less dexamethasone, and fewer pre-operative analgesics were associated with unfavorable outcomes (Group III vs. Group I).
Conclusions:
- Significant deficits exist in the administration and dosing of analgesics for pediatric surgical patients.
- Implementing timely and adequate analgesic administration is feasible for daily clinical practice.
Background:
Pain after paediatric appendectomy and tonsillectomy is often undertreated. Benchmarking of hospitals could reveal which measures are associated with improved patient- or parent-reported pain-related outcomes.
Methods:
A total of 898 anonymised cases from 11 European hospitals participating in PAIN OUT infant were analysed. The children completed a questionnaire on patient-reported outcomes (PROs) 24 h after surgery. According to a composite PRO measure, including pain intensity and pain-related interference, hospitals were allocated to Group I (favourable results), II (average results), and III (unfavourable results). Benchmarking of hospital groups was performed investigating process variables (dosing of non-opioid analgesics, opioids, and dexamethasone) associated with PROs, side-effects, and children's perception of care. Variables associated with PROs were analysed using multinomial regression analysis with the PRO score-related hospital group as a dependent variable (estimated odds ratios [OR], 95% confidence interval [CI]).
Results:
During the first 24 h after surgery, 1.2 (1.1-1.3) full daily doses of non-opioid analgesics (non-steroidal anti-inflammatory drug [NSAID], paracetamol, metamizole) were administered in group I and 0.7 (0.6-0.8) in group III (P<0.001). Intraoperative dexamethasone was administered to 70.1 and 52.6% of the children in Group I and Group III, respectively (P<0.001). A lower number of full daily doses of non-opioid analgesics: 0.22 [0.15-0.31]), less dexamethasone (0.49 [0.33-0.71]), fewer non-opioid analgesics before the end of surgery (0.37 [0.22-0.62]) and higher opioid doses were associated with hospital allocation to group III vs group I (Nagelkerke's R2=0.433).
Conclusions:
The results indicated substantial deficits in the concept, application, and dosing of analgesics in paediatric patients after surgery. Timely administration of adequate analgesic doses can easily be introduced into daily clinical practice.
Clinical Trial Registration:
clinicaltrials.gov NCT02083835.
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