Natural course of long-term postherniorrhaphy pain in a population-based cohort

2010 ◽  
Vol 1 (1) ◽  
pp. 55-59 ◽  
Author(s):  
Gabriel Sandblom ◽  
Maija-Liisa Kalliomäki ◽  
Ulf Gunnarsson ◽  
Torsten Gordh
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Population Based ◽  
Persistent Pain ◽  
Natural Course ◽  
Hernia Surgery ◽  
Persistent Postoperative Pain ◽  
Postherniorrhaphy Pain

AbstractBackgroundPersistent pain after hernia repair is widely recognised as a considerable problem, although the natural course of postoperative pain is not fully understood. The aim of the present study was to explore the natural course of persistent pain after hernia repair in a population-based cohort and identify risk factors for prolonged pain duration.MethodsThe study cohort was assembled from the Swedish Hernia Register (SHR), which has compiled detailed information on more than 140 000 groin hernia repairs since 1992. All patients operated on for groin hernia in the County of Uppsala, Sweden, 1998–2004 were identified in the SHR. Those who were still alive in 2005 received the Inguinal Pain Questionnaire, a validated questionnaire with 18 items developed with the aim of assessing postherniorrhaphy pain, by mail. Reminders were sent to non-responders 5 months after the first mail. The halving time was estimated from a linear regression of the logarithmic transformation of the prevalence of pain each year after surgery. A multivariate analysis with pain persisting more than 1 month with a retrospective question regarding time to pain cessation as dependent variable was performed.ResultsAltogether 2834 repairs in 2583 patients were recorded, 162 of who had died until 2005. Of the remaining patients, 1763 (68%) responded to the questionnaire. In 6.7 years the prevalence of persistent pain had decreased by half for the item “pain right now” and in 6.8 years for the item “worst pain last week”. The corresponding figures if laparoscopic repair was excluded were 6.4 years for “pain right now” and 6.4 years for “worst pain past week”. In a multivariate analysis, low age, postoperative complication and open method of repair were found to predict an increased risk for pain persistence exceeding 1 month.ConclusionPersistent postoperative pain is a common problem following hernia surgery, although it often recedes with time. It is more protracted in young patients, following open repair and after repairs with postoperative complications. Whereas efforts to treat persistent postoperative pain, in particular neuropathic pain, are often fruitless, this group can at least rely on the hope that the pain, for some of the patients, gradually decreases with time. On the other hand, 14% still reported a pain problem 7 years after hernia surgery. We do not know the course after that.Although no mathematical model can provide a full understanding of such a complex process as the natural course of postoperative pain, assuming an exponential course may help to analyse the course the first years after surgery, enable comparisons with other studies and give a base for exploring factors that influence the duration of the postoperative pain. Halving times close to those found in our study could also be extrapolated from other studies, assuming an exponential course.

Reoperation for persistent pain after groin hernia surgery: a population-based study

Hernia ◽  
2014 ◽  
Vol 19 (1) ◽  
pp. 45-51 ◽  
Author(s):  
N. Magnusson ◽  
U. Gunnarsson ◽  
P. Nordin ◽  
S. Smedberg ◽  
M. Hedberg ◽  
...  
Keyword(s):  
Groin Hernia ◽  
Population Based ◽  
Persistent Pain ◽  
Hernia Surgery ◽  
Population Based Study ◽  
Groin Hernia Surgery

scholarly journals Ambulatory Hernia Repair: A Study of 1294 Patients in a Single Institution

2021 ◽  
Author(s):  
Mohamed Hajri ◽  
Dhafer Haddad ◽  
Mouna Cherif ◽  
Alia Zouaghi ◽  
Nizar Khedhiri ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Mortality Rate ◽  
Hernia Repair ◽  
Failure Rate ◽  
Groin Hernia ◽  
Study Data ◽  
Morbidity Rate ◽  
Unplanned Admission ◽  
Single Institution ◽  
Hernia Surgery

Abstract Background: Ambulatory surgery is defined as surgery without an overnight hospital stay, which allows the patient to return home on the same day of admission after the surgical procedure. It is increasing countinuously in the world because of its several advantages. This study aimed to describe the experience of our department in outpatient hernia surgery, evaluate its feasibility and safety, and determine the predictive factors for failure of this surgery. Results: We collected 1294 patients. One thousand twenty patients underwent groin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3%) had an unplanned admission (UA) and 7 patients (0.7%) had an unplanned rehospitalisation (UR). Morbidity rate was 2.4% (24 patients) and mortality rate was zero. In multivariate analysis, we did not identify any variable predicting discharge failure in the GHR group. Two hundred and seventy-four patients underwent ventral hernia repair (VHR). The failure rate of ambulatory management of VHR was 5.5%: 11 patients (4%) had a UA and 4 patients (1.5%) had an UR. Morbidity rate was 3.6% (10 patients) and the mortality rate was zero. In multivariate analysis, we did not identify any variable predicting discharge failure in the VHR group. Conclusions: Our study data suggest that ambulatory hernia surgery is feasible and safe in well-selected patients. The development of this practice would allow for better management of eligible patients and would offer many economic and organisational advantages to healthcare structures.

Identification of biological risk factors for persistent postoperative pain after total knee arthroplasty

2021 ◽  
pp. rapm-2021-102953
Author(s):  
Alexandra Sideris ◽  
Michael-Alexander Malahias ◽  
George Birch ◽  
Haoyan Zhong ◽  
Valeria Rotundo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Synovial Fluid ◽  
Knee Arthroplasty ◽  
Persistent Pain ◽  
Patient Specific ◽  
Multiple Time ◽  
Cytokine Levels ◽  
Total Knee ◽  
Persistent Postoperative Pain

BackgroundThere is growing evidence that cytokines and adipokines are associated with osteoarthritis (OA) severity, progression, and severity of associated pain. However, the cytokine response to total knee arthroplasty (TKA) and its association with persistent postoperative pain is not well understood. This study aims to describe the perioperative systemic (plasma) and local (synovial fluid) cytokine profiles of patients who do and do not develop persistent pain after TKA.MethodsPatients undergoing primary unilateral TKA for end-stage OA were prospectively enrolled. Demographic and clinical data were gathered preoperatively and postoperatively. Synovial fluid was collected pre arthrotomy and plasma was collected at multiple time points before and after surgery. Persistent postoperative pain (PPP) was defined as Numerical Rating Score≥4 at 6 months. Cytokine levels were measured using the V-Plex Human Cytokine 30-Plex Panel (Mesoscale—Rockville, Maryland, USA). Cytokine levels were compared between PPP and minimal pain groups. Given that the study outcomes are exploratory, no adjustment was performed for multiple testing.ResultsIncidence of persistent pain at 6 months post TKA was 15/162 (9.3%). Postoperative plasma levels of four cytokines were significantly different in patients who developed persistent postoperative pain: interleukin (IL)-10, IL-1β, vascular endothelial growth factor, and IL12/IL23p40. Significantly lower IL-10 levels in the prearthrotomy synovial fluid were associated with development of postoperative persistent pain.ConclusionsThis prospective cohort study described a distinct acute perioperative inflammatory response profile in patients who developed persistent post-TKA pain, characterized by significant differences in four cytokines over the first 2 postoperative days. These results support the growing evidence that the patient-specific biologic response to surgery may influence longer-term clinical outcomes after TKA.Trial registration numberClinicaltrials.gov NCT02626533.

EP.TH.747Audit of antibiotic prophylaxis in groin hernia repair

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Maitreyi Patel ◽  
Aleem O'Balogun ◽  
Naveed Kirmani
Keyword(s):  
Hernia Repair ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Groin Hernia ◽  
Open Repair ◽  
Risk Category ◽  
Site Infection ◽  
Groin Hernia Repair ◽  
Hernia Surgery ◽  
International Guidelines

Abstract Aims To review practice of antibiotic prophylaxis in patients undergoing groin hernia repair against the International guidelines for groin hernia management 2018, in order to improve compliance with International Guidelines. We also assessed the risk category of patients. Methods Retrospective data of all patients undergoing groin hernia repair from November 2019 to March 2020 was collected using hospital software. Data collected included patient demographics, details of hernia repair including; primary/recurrent hernia, emergency/elective, laparoscopic/open repair and use of mesh. The details of antibiotic prophylaxis were recorded. Descriptive statistics was used. Data was analyzed using Microsoft Excel. Results 67 patients were included, of which 38(57%) were high risk. 62 (92.5%) primary repairs were done, of which 48(72%) were open. 62(92.5%) were operated electively. 46(69%) patients underwent open repair with mesh, 6(9%) had open repair without mesh, while 15(22%) had laparoscopic repair with mesh. A total of 45 (67%) patient received antibiotic prophylaxis. Adherence to International guidelines for groin hernia in open hernia surgery was 82.67%, while that for laparoscopic surgery was 60%. Overall adherence to the Guidelines was 56.67%. Conclusions The audit reflects the need for improved understanding and adherence to the International Guidelines. Data collection of surgical site infection can help inform and influence practice to minimize the risk for surgical site infection and assist in better communication with patients regarding risk. Risk assessment for surgical site infection of patients prior to procedure helps to identify those with indication of antibiotic prophylaxis.

scholarly journals Audit of Referral Patterns for Hernia Repair – Are General Practitioners Aware of the Changing Face of Herniorrhaphy?

2008 ◽  
Vol 90 (2) ◽  
pp. 140-141 ◽  
Author(s):  
JE Coulston ◽  
GL Williams ◽  
BM Stephenson
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
General Practitioners ◽  
Groin Hernia ◽  
Postal Questionnaire ◽  
Further Education ◽  
General Surgeon ◽  
Hernia Surgery ◽  
Referral Patterns ◽  
Inguinal Hernia Surgery

INTRODUCTION The objective of this study was to examine referral patterns from general practitioners for groin hernia surgery and to assess their knowledge of services available to their patients. PATIENTS AND METHODS An anonymous postal questionnaire was sent to 120 general practitioners (GPs) in the South East Wales region who routinely refer patients for inguinal hernia surgery to the Royal Gwent Healthcare NHS Trust. RESULTS A total of 86 questionnaire replies were returned. There was variation in referral patterns between the GPs with the majority (84%) referring their patients for groin hernia repair to either a general surgeon or as an open referral. Only 14% referred directly to a hernia specialist and none regularly referred to a laparoscopic surgeon. CONCLUSIONS Referral patterns for inguinal hernia surgery do not reflect services provided in secondary care. Further education is required so that a patient's care can be optimised.

scholarly journals Chronic Pain after Inguinal Hernia Repair

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Mallikarjuna Manangi ◽  
Santhosh Shivashankar ◽  
Abhishek Vijayakumar
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Nerve Injury ◽  
Statistical Significance ◽  
Preemptive Analgesia ◽  
Preoperative Pain ◽  
Hernia Surgery

Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of six months. Detailed preoperative, intraoperative, and postoperative details of cases were recorded according to proforma. The postoperative pain and pain at days two and seven and at end of six months were recorded on a VAS scale. Results. Chronic pain at six-month followup was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7% of patients with preoperative pain developed chronic pain. Preemptive analgesia failed to show statistical significance in development of chronic pain (P=0.079). Nerve injury was present in 22 of cases; it was found that nerve injury significantly affected development of chronic pain (P=0.001). On multivariate analysis, it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, postoperative local infiltration, postoperative complication, and most importantly the early postoperative pain. Conclusions. In the present study, we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves are very important. Early diagnosis and management of chronic pain can remove suffering of the patient.

scholarly journals Predictors of Persistent Postoperative Pain at Minimum Two-years After Arthroscopic Treatment of Femoroacetabular Impingement

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0020
Author(s):  
Austin V. Stone ◽  
Philip Malloy ◽  
William H. Neal ◽  
Edward Beck ◽  
Brian Robert Waterman ◽  
...  
Keyword(s):  
Mental Health ◽  
Postoperative Pain ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Persistent Pain ◽  
Anxiety And Depression ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Persistent Postoperative Pain

Objectives: To evaluate predictors for persistent postoperative pain following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We hypothesized that patients with chronic preoperative pain, smokers, and those with co-morbid mental health disease would have greater persistent postoperative pain. Methods: Patients undergoing hip arthroscopy for FAIS were identified in a prospectively collected database with a minimum of two-year follow-up with patient reported outcomes (PROs). Previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by VAS-Pain scores as limited (≤30) and persistent (>30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression to identify predictors of postoperative pain. Results: The limited pain (n=514) and persistent pain (n=174) groups totaled 688 patients (449 females). The persistent pain group was significantly older with a greater proportion of revision arthroscopy, worker’s compensation cases, smokers, hypertension, a history of a psychiatric diagnosis and preoperative narcotic use. Both collegiate sport participation [odds ratio (OR) -6.09 (95% CI: -1.23--30.3, p=0.027) and frequent running (OR -1.75, 95% CI: -1.09--2.81; p=0.021) decreased risk for pain. Smokers were 2.22 times more likely to have persistent pain (p=0.032; 95% CI: 1.07-4.46). A history of anxiety and depression is associated with 2.87 greater risk for persistent pain (p=0.030; 95% CI: 1.11-7.45). Conclusion: Independent predictors for persistent postoperative pain include current smoking and mental health history positive for anxiety and depression. Running as a primary form of exercise and high-level athletic participation are protective against persistent pain. Additional risk factors for increased pain include increased age, workers’ compensation claim, previous comorbid disease treated with surgery, and decreased preoperative PROs. Our analysis demonstrated significant improvements in both pain and functional PROs in both the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly inferior PROs.

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