Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis

Lava Y. Patel, Brittany Lapin, Matthew E. Gitelis, Craig Brown, John G. Linn, Stephen Haggerty, Woody Denham, Zeeshan Butt, Ermilo Barrera, Ray Joehl, Jo Ann Carbray, Tyler Hall, Michael B. Ujiki*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient’s decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools. Methods: Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression. Results: From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months–2 years correlated more significantly with general health status than surgical factors. Conclusions: Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.

Original languageEnglish (US)
Pages (from-to)2109-2121
Number of pages13
JournalSurgical endoscopy
Volume31
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Inguinal Hernia
Herniorrhaphy
Pain
Quality of Life
Postoperative Pain
Databases
Health Status
Decision Making
Logistic Models
Health

Keywords

  • Chronic pain
  • Hernia repair
  • Inguinal groin
  • Quality of life
  • Totally extra-peritoneal (TEP) hernia repair

ASJC Scopus subject areas

  • Surgery

Cite this

Patel, L. Y., Lapin, B., Gitelis, M. E., Brown, C., Linn, J. G., Haggerty, S., ... Ujiki, M. B. (2017). Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis. Surgical endoscopy, 31(5), 2109-2121. https://doi.org/10.1007/s00464-016-5207-0
Patel, Lava Y. ; Lapin, Brittany ; Gitelis, Matthew E. ; Brown, Craig ; Linn, John G. ; Haggerty, Stephen ; Denham, Woody ; Butt, Zeeshan ; Barrera, Ermilo ; Joehl, Ray ; Carbray, Jo Ann ; Hall, Tyler ; Ujiki, Michael B. / Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair : a patient-centered analysis. In: Surgical endoscopy. 2017 ; Vol. 31, No. 5. pp. 2109-2121.
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abstract = "Background: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient’s decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools. Methods: Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression. Results: From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 {\%} male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 {\%} of respondents (158/301) preoperatively, and postoperatively by 50 {\%} at 3 weeks (111/220), 21 {\%} at 6 months (15/70), 13 {\%} at 1 year (14/108), and 25 {\%} at 2 years (30/121). Significant pain at 6 months–2 years correlated more significantly with general health status than surgical factors. Conclusions: Significant pain can be as high as 50 {\%} at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.",
keywords = "Chronic pain, Hernia repair, Inguinal groin, Quality of life, Totally extra-peritoneal (TEP) hernia repair",
author = "Patel, {Lava Y.} and Brittany Lapin and Gitelis, {Matthew E.} and Craig Brown and Linn, {John G.} and Stephen Haggerty and Woody Denham and Zeeshan Butt and Ermilo Barrera and Ray Joehl and Carbray, {Jo Ann} and Tyler Hall and Ujiki, {Michael B.}",
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Patel, LY, Lapin, B, Gitelis, ME, Brown, C, Linn, JG, Haggerty, S, Denham, W, Butt, Z, Barrera, E, Joehl, R, Carbray, JA, Hall, T & Ujiki, MB 2017, 'Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis', Surgical endoscopy, vol. 31, no. 5, pp. 2109-2121. https://doi.org/10.1007/s00464-016-5207-0

Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair : a patient-centered analysis. / Patel, Lava Y.; Lapin, Brittany; Gitelis, Matthew E.; Brown, Craig; Linn, John G.; Haggerty, Stephen; Denham, Woody; Butt, Zeeshan; Barrera, Ermilo; Joehl, Ray; Carbray, Jo Ann; Hall, Tyler; Ujiki, Michael B.

In: Surgical endoscopy, Vol. 31, No. 5, 01.05.2017, p. 2109-2121.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair

T2 - a patient-centered analysis

AU - Patel, Lava Y.

AU - Lapin, Brittany

AU - Gitelis, Matthew E.

AU - Brown, Craig

AU - Linn, John G.

AU - Haggerty, Stephen

AU - Denham, Woody

AU - Butt, Zeeshan

AU - Barrera, Ermilo

AU - Joehl, Ray

AU - Carbray, Jo Ann

AU - Hall, Tyler

AU - Ujiki, Michael B.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient’s decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools. Methods: Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression. Results: From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months–2 years correlated more significantly with general health status than surgical factors. Conclusions: Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.

AB - Background: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient’s decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools. Methods: Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression. Results: From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months–2 years correlated more significantly with general health status than surgical factors. Conclusions: Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.

KW - Chronic pain

KW - Hernia repair

KW - Inguinal groin

KW - Quality of life

KW - Totally extra-peritoneal (TEP) hernia repair

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