Effective pain control reduces postop hospitalization for THA, TKA

Reducing postop length of stay may help reduce overall patient cost and allow more patients to be admitted to the hospital.

Effective pain control, using continuous peripheral nerve block, can reduce the average length of postoperative hospitalization by almost 1 day, according to a study by researchers at the University of Pittsburgh School of Medicine.

Decreasing postop hospitalization can help reduce patients' risks for exposure to hospital-acquired infection and associated complications. It can also have an overall economic benefit, said Jacques E. Chelly, MD, PhD, in a press release from the university announcing the study findings.

Chelly is a professor and vice chairman of the university's department of anesthesiology. He presented the study results at the Clinical and Scientific Congress of the International Anesthesia Research Society in Orlando, Fla.

Chelly and colleagues analyzed hospitalization data for 1,527 patients who underwent total hip or total knee arthroplasty, thoracotomy and prostatectomy either before or after the implementation of an acute postoperative pain service program. Of the 1,527 patients, 495 received surgery between July 1, 2001, and Aug. 30, 2002, before the pain program was initiated. The remaining 1,032 patients received surgery between July 1, 2004, and Aug. 30, 2005, after the hospital initiated the pain program, according to the release.

Investigators found that length of hospitalization averaged 3.68 ? 1.5 days before initiation of the pain program, according to the study abstract. "The use of the acute interventional postoperative pain service allowed patients to recover faster, and they were discharged from the hospital an average of 0.675 days per patient earlier, for a total of 597.7 days of hospitalization saved a year," Chelly said in the release.

Before introducing the pain service, surgeons managed pain primarily by using morphine and patient-controlled analgesia, he noted. Involving anesthetists in a postoperative pain management program allows for expanded pain management options, he said. "Now, we can do a peripheral nerve block and use other medications, making postoperative pain control more effective," Chelly said in the release.

"Our data demonstrates that [acute postoperative pain service] can help reduce [length of hospitalization]. This represents a direct and indirect economic benefit. It reduces the overall patient cost (direct effect) and provides [an] opportunity to increase the number of patients being admitted (indirect effect)," the authors reported in the study abstract.

"This is especially interesting in hospitals within a very high occupancy ration. In the present model, the described reduction represents an opportunity for admitting an additional 234 patients per year," they wrote.

For more information:
Chelly JE, Friend K, Ben-David B, et al. Economic benefits of an acute interventional postoperative pain service. #S-75. Presented at the 81st Clinical and Scientific Congress of the International Anesthesia Research Society. March 23-27, 2007. Orlando, Fla.