Improving perioperative pain management among orthopaedic patients at a Gauteng private hospital: A PAIN OUT project

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Abstract
Background: Less than half of all orthopaedic patients undergoing surgery report adequate pain relief. PAIN OUT is an international registry that collects and compares patient–reported outcomes to support quality improvement in postoperative pain management. Aim: The aim of this study was to assess the impact of implementing a four–part perioperative pain management bundle by comparing pain outcomes pre– and post–bundle implementation in orthopaedic patients at a private hospital in Gauteng, South Africa. Setting: A single private hospital providing elective orthopaedic surgical care in Gauteng, South Africa. Methods: A pre–post observational audit was conducted using the PAIN OUT registry. Baseline data were collected from 86 patients (November 2021–March 2023), and post–implementation data from 105 patients (September 2023–March 2024). The bundle included patient education, non–opioid analgesia, regional anaesthesia and structured pain assessment. Results: In the post–implementation group, 95.23% of participants had their pain assessed and reassessed regularly, compared with 58.13% at baseline. All participants received regional anaesthesia and/or wound infiltration, compared with 30.23% at baseline. Overall, 65.71% of patients received all four elements of the bundle compared with 0% before implementation. Total pain composite scores, pain–related interference and side effects of pain management significantly improved post–implementation. Fewer patients reported wanting more analgesia (21.9% vs 48.84%; p < 0.01). Conclusion: Implementation of a four–part perioperative pain management bundle improved postoperative pain outcomes among orthopaedic patients and supports broader application of bundled approaches in diverse settings. Contribution: This study provides South African PAIN OUT data and demonstrates the feasibility and effectiveness of a standardised perioperative pain management bundle in the private hospital setting.

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