Predictors For Chronic Pain Following Laparoscopic Inguinal Hernia Repair
*Beau Forester, *Mikhail Attaar, *Sebastian Chirayil, *Kristine Kuchta, *Woody Denham, John Linn, *Stephen Haggerty, Michael Ujiki
NorthShore University HealthSystem, Evanston, IL
OBJECTIVE(S): Multiple studies have analyzed predictors for chronic pain after hernia repair, but most were limited to patients who underwent open repair. There is a lack of data regarding predictors of chronic pain in patients who undergo laparoscopic inguinal hernia repair (LIHR). The purpose of this study is to determine which factors predict the development of chronic pain following LIHR.
METHODS: We identified 1,730 patients who underwent LIHR with mesh between 2008-2019 at a single institution from a prospectively maintained quality database. All surgeries were performed by four board certified surgeons. Health-related quality of life outcomes were measured using the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys that were administered preoperatively, as well as three weeks, six months, one year, two years, and five years postoperatively. Patients were included if they had at least one survey response at any of the time points. We categorized a patient as suffering from chronic pain if their score on the CCS was greater than or equal to three, indicating moderate and/or daily symptoms or worse. Multivariable logistic regression analysis was used to identify predictors of chronic pain.
RESULTS: Mean age of the cohort was 59 (±15) years, mean BMI was 26.1 (±3.7) kg/m2 and mean preoperative visual analogue scale (VAS) score was 2.6 (±2.1). One hundred thirty-nine (8.0%) of the patients were female. The average follow up was 23 (11-59) months and 37 (2.1%) patients developed a recurrent hernia. Twenty (1.2%) patients experienced intraoperative complications. Seventeen (1.0%) patients were readmitted and four (0.2%) patients developed a surgical site infection within 30 days of the operation. There were 6.1% of patients reporting moderate and/or daily symptoms or worse (CCS≥3). On multivariable analysis, predictors for chronic pain (CCS≥3) were age younger than 45, (p<0.001), female gender (p=0.025), higher preoperative VAS ≥3 (p=0.016), and use of multifilament polyester mesh (p=0.027).
CONCLUSIONS: Laparoscopic inguinal hernia repair results in 6.1% of patients experiencing chronic pain at any time point greater than six months postoperatively. We found that younger age, female gender, higher preoperative VAS and use of polyester mesh were predictors for chronic pain.
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