Implementation of an Evidence-Based Protocol Significantly Reduces Opioid Prescribing After Ventral Hernia Repair

2020 ◽  
Vol 86 (11) ◽  
pp. 1602-1606
Author(s):  
Diana E. Peterman ◽  
Bryan P. Knoedler ◽  
Joseph A. Ewing ◽  
Alfredo M. Carbonell ◽  
William S. Cobb ◽  
...  
Keyword(s):  
South Carolina ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Program Analysis ◽  
Ventral Hernia Repair ◽  
Monitoring Program ◽  
Trend Test ◽  
Evidence Based ◽  
Opioid Use ◽  
Opioid Prescribing

Background Increased recognition of the dangers of opioid analgesia has led to significant focus on strategies for reducing use through multimodal analgesia, enhanced recovery protocols, and standardized guidelines for prescribing. Our institution implemented a standard protocol for prescribing analgesics at discharge after ventral hernia repair (VHR). We hypothesize that this strategy significantly reduces opioid use. Methods A standardized protocol for discharge prescribing was implemented in March 2018. Patients were prescribed ibuprofen, acetaminophen, and opioids based on milligram morphine equivalent (MME) use the 24 hours prior to discharge. We retrospectively reviewed prescriptions of opioids for two 6-month periods—July-December 2017 (PRE) and July-December 2018 (POST)—for comparison using EPIC report and the South Carolina Prescription Monitoring Program. Analysis performed included Mann-Kendall linear trend test and Student’s t-test for continuous variables. Results VHR was performed in 105 patients in the PRE and 75 patients in the POST group. Total MME prescribed decreased significantly from mean 322.7 + 261.3/median 225 (IQR 150-400) MME to 141.6 + 150.4/median 100 (50-184) MME ( P < .001). This represents a 57% reduction in mean opioid MME prescriptions. Acetaminophen prescribing increased from 10% to 65%, and ibuprofen from 7.6% to 61.3%. Refills were prescribed in 21 patients (20%) during the PRE period, which decreased to 10.7% during the POST group ( P = .141). Implementation of an evidence-based protocol significantly reduces opioid prescribing after VHR. Discussion A multimodal approach to postoperative pain management decreases the need for opioids. The additional implementation of an evidence-based prescribing protocol results in significant reduction of opioid use following VHR.

Effect of Multimodal Analgesia on Opioid Use After Open Ventral Hernia Repair

2017 ◽  
Vol 21 (10) ◽  
pp. 1692-1699 ◽  
Author(s):  
Jeremy A. Warren ◽  
Caroline Stoddard ◽  
Ahan L. Hunter ◽  
Anthony J. Horton ◽  
Carlyn Atwood ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Multimodal Analgesia ◽  
Opioid Use ◽  
Open Ventral Hernia Repair

scholarly journals Opioid Use and Incidence of Surgical Site Infection after Repair of Ventral and Incisional Hernia - A Prospective Clinical Study in a Tertiary Care Hospital in Tirupati

2021 ◽  
Vol 8 (22) ◽  
pp. 1841-1845
Author(s):  
Srikanth Reddy Challapalli ◽  
Venkata Prakash Gandikota ◽  
Theja Peddavenkatagiri ◽  
Harsha Vardhan Reddy Gerigi
Keyword(s):  
Hernia Repair ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Ventral Hernia ◽  
Postoperative Period ◽  
Ventral Hernia Repair ◽  
Care Hospital ◽  
Site Infection ◽  
Opioid Use ◽  
Opioid Users

BACKGROUND Preoperative opioid use is one of the predisposing factors for complications after most of the surgical procedures. This study intends to evaluate the effect of preoperative opiates on the outcomes following repair of ventral hernia. METHODS We conducted a prospective study of patients who underwent consecutive ventral hernia repair for over one year with institutional review board approval. Data were obtained regarding the usage of opioids during the preoperative period, intraoperative period, and postoperative period. Follow-up of the cases was done during the postoperative period. Data were obtained regarding the postoperative complications, duration of hospital stay, and the analyzed results. RESULTS A striking thirty percent of the total sixty patients have satisfied the criteria for the usage of opioids preoperatively. Preoperative history and operative details were found to be almost similar between the two categories of patients (no preoperative opioid use versus preoperative opioid use). The median hospital stay duration trended towards increased patients with opioid usage versus non-opioid users (P = 0.06). The bowel function's return to the normal was delayed in opioid users compared with non-opioid users (P = 0.018). The risk of superficial surgical site infection was increased among patients who used opioids preoperatively than the patients without preoperative opioid usage (55.5 % vs. 9.5 %; P < 0.001) and remained the same after multivariable logistic regression. CONCLUSIONS Among patients who underwent repair of ventral hernia, those with preoperative opioid usage experienced an increased risk of superficial surgical site infection than patients without preoperative opioid usage. KEYWORDS Opioid, Ventral Hernia Repair, Surgical Site Infection

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

Platelet Rich Plasma Enhances Mechanical Strength of Strattice in Rat Model of Ventral Hernia Repair.

2021 ◽  
Author(s):  
Joseph S. Fernandez‐Moure ◽  
Jeffrey L. Van Eps ◽  
Jacob C. Scherba ◽  
Iman K. Yazdi ◽  
Andrew Robbins ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Mechanical Strength ◽  
Ventral Hernia ◽  
Rat Model ◽  
Ventral Hernia Repair ◽  
Platelet Rich Plasma

scholarly journals Long term outcome and elasticity of a polyester mesh used for laparoscopic ventral hernia repair

Hernia ◽  
2021 ◽  
Author(s):  
P. J. O’Dwyer ◽  
C. Chew ◽  
H. Qandeel
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Laparoscopic Repair ◽  
Ventral Hernia Repair ◽  
Laparoscopic Ventral Hernia Repair ◽  
Ct Scans ◽  
Unique Problem ◽  
Polyester Mesh

Abstract Background Repair of a ventral hernia is increasingly being performed by a laparoscopic approach despite lack of good long term follow up data on outcomes. The aim of this study was to examine the long term performance of a polyester mesh and to assess its elastic properties in patients undergoing laparoscopic ventral hernia repair. Methods All patients being assessed for a ventral hernia repair between August 2011 and November 2013 were placed on a prospective database. Those undergoing laparoscopic repair with a polyester mesh were seen at clinic at one month and one year, while their electronic records were assessed at 34 months (range 24–48 months) and 104 months (range 92–116 months). In addition, CT scans of the abdomen and pelvis performed for any reason on these patients during the follow up period were reviewed by a consultant gastrointestinal radiologist. Mechanical failure testing of the mesh was also performed. Results Thirty-two of the 100 patients assessed for ventral hernia repair had a laparoscopic repair with a polyester mesh. Nineteen (59%) had CT scans performed during the follow-up period. No recurrence was recorded at 34 months, while three (9.4%) had a recurrence at 104 months. Two had central breakdown of the mesh at 81 and 90 months, while 1 presented acutely at 116 months after operation. Mesh had stretched across the defect by an average of 21% (range 5.7–40%) in nine patients. Mechanical testing showed that this mesh lost its elasticity at low forces ranging between 1.8 and 3.2 N/cm. Conclusion This study shows that late recurrence is a problem following laparoscopic ventral hernia repair with polyester mesh. The mesh loses it elasticity at a low force. This combined with degradation of mesh seems the most likely cause of failure. This is unlikely to be a unique problem of polyester mesh and further long-term studies are required to better assess this operative approach to ventral hernia repair.

Reducing Length of Stay Using a Robotic-assisted Approach for Retromuscular Ventral Hernia Repair

2018 ◽  
Vol 267 (2) ◽  
pp. 210-217 ◽  
Author(s):  
Alfredo M. Carbonell ◽  
Jeremy A. Warren ◽  
Ajita S. Prabhu ◽  
Conrad D. Ballecer ◽  
Randy J. Janczyk ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Robotic Assisted
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