Smaller Inguinal Hernias are Independent Risk Factors for Developing Chronic Postoperative Inguinal Pain (CPIP): A Registry-based Multivariable Analysis of 57, 999 Patients.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
pubmed:
12
10
2018
medline:
5
6
2020
entrez:
12
10
2018
Statut:
ppublish
Résumé
Impact of inguinal hernia defect size as stratified by the European Hernia Society (EHS) classification I to III on the rate of chronic postoperative inguinal pain (CPIP). CPIP is the most important complication after inguinal hernia repair. The impact of hernia defect size according to the EHS classification on CPIP is unknown. In total, 57,999 male patients from the Herniamed registry undergoing primary unilateral inguinal hernia repair including a 1-year follow-up were selected between September 1, 2009 and November 30, 2016. Using multivariable analysis, the impact of EHS inguinal hernia classification (EHS I vs EHS II vs EHS III and/or scrotal) on developing CPIP was investigated. Multivariable analysis revealed for smaller inguinal hernias a significant higher rate of pain at rest [EHS I vs EHS II: odds ratio, OR = 1.350 (1.180-1.543), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 1.839 (1.504-2.249), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.363 (1.125-1.650), P = 0.002], pain on exertion [EHS I vs EHS II: OR = 1.342 (1.223-1.473), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 2.002 (1.727-2.321), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.492 (1.296; 1.717), P < 0.001], and pain requiring treatment [EHS I vs EHS II: OR = 1.594 (1.357-1.874), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 2.254 (1.774-2.865), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.414 (1.121-1.783), P = 0.003] at 1-year follow-up. Younger patients (<55 y) revealed higher rates of pain at rest, pain on exertion, and pain requiring treatment (each P < 0.001) with a significantly trend toward higher rates of pain in smaller hernias. Smaller inguinal hernias have been identified as an independent patient-related risk factor for developing CPIP.
Sections du résumé
OBJECTIVE
Impact of inguinal hernia defect size as stratified by the European Hernia Society (EHS) classification I to III on the rate of chronic postoperative inguinal pain (CPIP).
BACKGROUND
CPIP is the most important complication after inguinal hernia repair. The impact of hernia defect size according to the EHS classification on CPIP is unknown.
METHODS
In total, 57,999 male patients from the Herniamed registry undergoing primary unilateral inguinal hernia repair including a 1-year follow-up were selected between September 1, 2009 and November 30, 2016. Using multivariable analysis, the impact of EHS inguinal hernia classification (EHS I vs EHS II vs EHS III and/or scrotal) on developing CPIP was investigated.
RESULTS
Multivariable analysis revealed for smaller inguinal hernias a significant higher rate of pain at rest [EHS I vs EHS II: odds ratio, OR = 1.350 (1.180-1.543), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 1.839 (1.504-2.249), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.363 (1.125-1.650), P = 0.002], pain on exertion [EHS I vs EHS II: OR = 1.342 (1.223-1.473), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 2.002 (1.727-2.321), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.492 (1.296; 1.717), P < 0.001], and pain requiring treatment [EHS I vs EHS II: OR = 1.594 (1.357-1.874), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 2.254 (1.774-2.865), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.414 (1.121-1.783), P = 0.003] at 1-year follow-up. Younger patients (<55 y) revealed higher rates of pain at rest, pain on exertion, and pain requiring treatment (each P < 0.001) with a significantly trend toward higher rates of pain in smaller hernias.
CONCLUSIONS
Smaller inguinal hernias have been identified as an independent patient-related risk factor for developing CPIP.
Identifiants
pubmed: 30308610
doi: 10.1097/SLA.0000000000003065
pii: 00000658-202004000-00025
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
756-764Références
Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 2003; 362:1561–1571.
The Herniasurge Group. International guidelines for groin hernia management. Hernia 2018; 22:1–165.
Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25:2773–2843.
International Association for the Study of Pain. Classification of chronic pain syndromes and definitions of pain terms. Pain 1986; 3:S1–S226.
Köckerling F, Bittner R, Kofler M, et al. Lichtenstein versus total extraperitoneal patch plasty versus transabdominal patch plasty technique for primary unilateral inguinal hernia repair. Ann Surg 2017; doi: 10.1097/SLA.0000000000002541. [Epub ahead of print].
doi: 10.1097/sla.0000000000002541.
Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 2011; 15:239–249.
Aasvang EK, Gmaehle E, Hansen JB, et al. Predictive risk factors for persistent postherniotomy pain. Anesthesiology 2010; 112:957–969.
Reinpold W. Risk factors of chronic pain after inguinal hernia repair: a systematic review. Innov Surg Sci 2017; 2:61–68.
Shah NS, Fullwood C, Siriwardena AK, et al. Mesh fixation at laparoscopic inguinal hernia repair: a meta-analysis comparing tissue glue and tack fixation. World J Surg 2015; 38:2558–2570.
Köckerling F, Koch A, Adolf D, et al. Has shouldice repair in a selected group of patients with inguinal hernia comparable results to lichtenstein, TEP and TAPP techniques? World J Surg 2018; 42:2001–2010.
Miserez M, Alexandre JH, Campanelli G, et al. The European hernia society groin hernia classication: simple and easy to remember. Hernia 2007; 11:113–116.
Mayer F, Niebuhr H, Lechner M, et al. When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary? The register-based analysis of 11,230 cases. Surg Endosc 2016; 30:4363–4371.
Stechemesser B, Jacob DA, Schug-Pass C, et al. Herniamed: an Internet-based registry for outcome research in hernia surgery. Hernia 2012; 16:269–276.
Hu QL, Chen DC. Approach to the patient with chronic groin pain. Surg Clin North Am 2018; 98:651–665.
Haapaniemi S, Nilsson E. Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up. Eur J Surg 2002; 168:22–28.
Olsson A, Sandblom G, Fränneby U, et al. Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair. Surgery 2017; 161:509–516.
Sousa G, Mendonça J, Brandão J, et al. Chronic post-surgical pain and its impact on quality of life and recovery after surgery: 14AP9-7. Eur J Anaesthesiol 2014; 31:239–240.
Philip BK, Reese PR, Burch SP. The economic impact of opioids on postoperative pain management. J Clin Anesth 2002; 14:354–364.
Nienhuijs SW, Rosman C, Strobbe LJA, et al. An overview of the features influencing pain after inguinal hernia repair. Int J Surg 2008; 6:351–356.
Wiering B, de Boer D, Delnoij D. Meeting patient expectations: patient expectations and recovery after hip or knee surgery. Musculoskelet Surg 2017; doi: 10.1007/s12306-017-0523-7. [Epub ahead of print].
doi: 10.1007/s12306-017-0523-7.
Wallace LM. Surgical patients’ expectations of pain and discomfort: does accuracy of expectations minimise post-surgical pain and distress? Pain 1985; 22:363–373.
Waljee J, McGlinn EP, Sears ED, et al. Patient expectations and patient-reported outcomes in surgery: a systematic review. Surgery 2014; 155:799–808.
Thompson T, Correll CU, Gallop K, et al. Is pain perception altered in people with depression? A systematic review and meta-analysis of experimental pain research. J Pain 2016; 17:1257–1272.
Woo AK. Depression and anxiety in pain. Rev Pain 2010; 4:8–12.
Rustøen T, Wahl AK, Hanestad BR, et al. Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults. Clin J Pain 2005; 21:513–523.
Dominguez CA, Kalliomäki M, Gunnarsson U, et al. The DQB1∗03:02 HLA haplotype is associated with increased risk of chronic pain after inguinal hernia surgery and lumbar disc herniation. Pain 2013; 154:427–433.
Belfer I, Dai F, Kehlet H, et al. Association of functional variations in COMT and GCH1 genes with postherniotomy pain and related impairment. Pain 2015; 156:273–279.
Köckerling F, Schug-Pass C. Tailored approach in inguinal hernia repair—decision tree based on the guidelines. Front Surg 2014; 1:7–10.
Holmich P, Dienst M. Differentialdiagnose von Hüft-und Leistenschmerzen. Orthopäde 2006; 35:8–15.
Fitzgibbons RJ, Ramanan B, Arya S, et al. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg 2013; 258:508–515.
Hannan EL, Cozzens K, King SB, et al. The New York State Cardiac Registries: history, contributions, limitations, and lessons for future efforts to assess and publicly report healthcare outcomes. J Am Coll Cardiol 2012; 59:2309–2316.
McLean KA, Sheng Z, O’Neill S, et al. The Influence of clinical and patient-reported outcomes on post-surgery satisfaction in cholecystectomy patients. World J Surg 2017; 41:1752–1761.