Background and goal of the study:

To describe the frequency of acute postoperative pain (APOP), recorded by means of pain indicators in electronic clinical histories (ECHs), according to All Patient Refined-Diagnostic Related Group (APR-DRG) categories. The APR-DRGs codes group patients according to similarity of clinical characteristics, diagnostic and procedures undertaken, and intensity of resource requirements. This universal classification system makes it possible to compare patients with the same surgeries and complexity within and between hospitals (benchmarking).

Materials and Methods:

A pain chart was developed for recording APOP indicators from the ECHs. This chart enabled real-time study of interactions between indicators and APR-DRGs. We analyzed the percentages of patients in 9 APR–GRDs who reported pain > 3 and > 7 on a numerical rating scale (NRS) during the first 24 hours after surgery. The data were analyzed and are presented as bi-monthly percentages.

Results:

Table 1 shows the percentage of patients with NRS > 3 and > 7 within 24 hours of surgery in the 9 APR-DRGs. The frequencies of pain > 3 and > 7 were higher in patients undergoing grade II surgeries (225, appendicectomy; 263, laparoscopic cholecystectomy) than in patients undergoing some types of grade III surgeries (120, thoracic; 221, colon; 260, liver and pancreas). However, another grade III procedure, orthopedic surgery , had the highest percentage of patients with pain > 3 and > 7.

Conclusions:

Patients undergoing grade III surgeries generally experienced better pain control, with the exception of orthopedic surgery, which continues to cause poorly controlled pain. This study approach using APOP indicators from ECHs may be applicable to all surgical settings.

Analysis of pain indicators in a tertiary care hospital: study based on electronic clinical histories