Here - EWMA 2013

POSTER PRESENTATIONS
P 325
Health economic evaluation of post-operative pain therapy
in routine care
Poster: Pain
Matthias Augustin 3 , Magdalena Krensel 1 , Christina Spehr 1 , Jürgen Osterbrink 2
1 University Medical Center Hamburg-Eppendorf, CVderm (Hamburg, Germany);
2 Paracelsus Medizinische Privatuniversität (Salzburg, Austria);
3 Institute for Health Services Research in Dermatology and Nursing, University Clinics of
Hamburg
In Germany 2 - 4.5 million persons suffer from post-operative pain. The objective of the
health services research project “Action Alliance Painfree City Münster” with an ex-post
facto design was to evaluate the health care situation of patients with post-operative
pain. The aim of the present evaluation was a first cost analysis of post-op pain therapy
under routine care in several hospitals.
The health economic analyses were made on the basis of six municipal hospitals of the
city of Münster. Costs of pain care at the first day post-op were calculated on the basis
of resource use and determined on the perspective of hospitals. Relevant for evaluation
was the post-operative pain, measured by a 10-digit numeric rating scale (NRS).
From the n=708 examined patients n=663 (93.6%) received a post-op pain therapy. The
average costs were 6.45 € per day and patient. From these total costs medical products
accounted for 42.3%, modality for 16.4% and consumables of analgesia for 41.2%.
23.8% of the patients were still not adequately provided with pain therapy (rest pain
NRS>4). There was no correlation between post-op pain and the cost of pain therapy.
The post-op pain therapy, even under optimized therapy conditions, has only a marginal
influence on the health care system expenses.
POSTER: PRESSURE ULCER
P 326
Poster: Pressure Ulcer
THE USE OF HEMOGLOBIN SATURATION RATIO AS A MEANS OF MEASURING
TISSUE PERFUSION IN THE DEVELOPMENT OF HEEL PRESSURE SORES
Kristen Aliano 1 , Steve Stavrides 1 , Thomas Davenport 1
1 Long Island Plastic Surgical Group (Garden City, United States).
Aim: The heel is a common site of pressure wounds. We studied the use of the
hemoglobin saturation ratio as a means of assessing heel perfusion in various pressure
settings.
Methods: The mixed perfusion ratio in the heels of five volunteers was assessed on
three pressure surfaces and at off-load as a baseline. The surfaces studied were
stretcher pad, plastic backboard without padding, and pressure reduction gel. Each
surface was measured for five minutes with a real time reading.
Results: On the stretcher, the average hemoglobin saturation ratio (StO2%) decrease
was 26.2± 10. The average StO2% decrease on the backboard was 22.8 ± 12.3, and
24.0 ± 4.8 on the gel pad. The StO2% drop had a leveling off with stretcher, and gel pad
but with backboard had a continued slow drop at 5 minutes.
Conclusions: This study demonstrates that hemoglobin oxygenation ratio can be used
to assess a tissues direct perfusion in the setting of tissue pressure and can also be
used to better assess the affects of pressure reduction surfaces. Using this method, a
comparison of surfaces reveal a continued drop with a hard surface and plateau with all
other surfaces. A comparison of gel versus stretcher shows a comparable reduction in
tissue perfusion and therefore a similar pressure and shear reduction effect. While
oxygenation ratios can be used to assess pressure precautions in skin care, further
studies will be needed to determine time to skin breakdown as they pertain to pressure
and tissue oxygenation.
192