Influence of a New "Call-Out Algorithm" for Management of Postoperative Pain and Its Side Effects on Length of Stay in Hospital: A Two-Centre Prospective Randomized Trial

Lisa Dybvik, Erlend Skraastad, Aigerim Yeltayeva, Aidos Konkayev, Tatiana Musaeva, Igor Zabolotskikh, Lars Bjertnaes, Vegard Dahl, Johan Raeder, Vladimir Kuklin, Lisa Dybvik, Erlend Skraastad, Aigerim Yeltayeva, Aidos Konkayev, Tatiana Musaeva, Igor Zabolotskikh, Lars Bjertnaes, Vegard Dahl, Johan Raeder, Vladimir Kuklin

Abstract

Background: We recently introduced the efficacy safety score (ESS) as a new "call-out algorithm" for management of postoperative pain and side effects. In this study, we report the influence of ESS recorded hourly during the first 8 hours after surgery on the mobility degree, postoperative nonsurgical complications, and length of hospital stay (LOS).

Methods: We randomized 1152 surgical patients into three groups for postoperative observation: (1) ESS group (n = 409), (2) Verbal Numeric Rate Scale (VNRS) for pain group (n = 417), and (3) an ordinary qualitative observation (Control) group (n = 326). An ESS > 10 or VNRS > 4 at rest or a nurse's observation of pain or adverse reaction to analgesic treatment in the Control group served as a "call-out alarm" for an anaesthesiologist.

Results: We found no significant differences in the mobility degree and number of postoperative nonsurgical complications between the groups. LOS was significantly shorter with 12.7 ± 6.3 days (mean ± SD) in the ESS group versus 14.2 ± 6.2 days in the Control group (P < 0.001).

Conclusion: Postoperative ESS recording in combination with the possibility to call upon an anaesthesiologist when exceeding the threshold score might have contributed to the reductions of LOS in this two-centre study. This trial is registered with NCT02143128.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Length of hospital stay (LOS) of patients included in the study in University Hospital of Astana, Astana, Kazakhstan (n = 679). Data are presented as vertical boxes with median (solid line), mean (dashed line), and interquartile range with 10th percentile and 90th percentile error bars. Outliers are presented as open circles. ∗P = 0.011 comparing ESS group versus Control group.
Figure 3
Figure 3
Length of hospital stay (LOS) of patients included in the study in University Hospital of Krasnodar, Krasnodar, Russia (n = 473). Data are presented as vertical boxes with median (solid line), mean (dashed line), and interquartile range with 10th percentile and 90th percentile error bars. In the VNRS group, the 10th percentile error bar is matching with the lower line of the box. Outliers are presented as open circles. ∗P = 0.022 comparing ESS group versus Control group.
Figure 4
Figure 4
Length of hospital stay (LOS) of patients included in the study from both hospitals (n = 1152). Data are presented as vertical boxes with median (solid line), mean (dashed line), and interquartile range with 10th percentile and 90th percentile error bars. Outliers are presented as open circles. ∗P < 0.001 comparing ESS group versus Control group.
Figure 5
Figure 5
Length of hospital stay (LOS) of patients included in the study after laparoscopic cholecystectomy from both hospitals (n = 114). Data are presented as vertical boxes with mean (dashed line) and interquartile range with 10th percentile and 90th percentile error bars. In the ESS and VNRS groups, the 10th percentile error bar is matching with the lower lines of the boxes. Outliers are presented as open circles. #ESS group versus Control group, P = 0.003; #ESS group versus VNRS group, P < 0.001.

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