Robert Mckay, MD. Ellis Hospital
INTRODUCTION: To date, no sensitive measure has been used to quantify urinary symptoms in patients undergoing transabdominal preperitoneal (TAPP) inguinal hernia repair in the 24- to 48- hr postoperative period. The American Urological Society Score (AUASS) is a validated score for urinary symptoms for benign prostate hypertrophy (BPH). This has been applied to TAPP inguinal hernia repair. METHODS AND PROCEDURES: Men (n = 134), mean age 48.8 years (range, 20 to 87), underwent TAPP inguinal hernia repair. Hernia repair was divided into bilateral and unilateral repair. Unilateral repair was further divided into isolated direct and indirect hernia. Preoperative and postoperative 24- and 48-hr AUASS’ were obtained. AUASS was recorded as: 1-7, mild; 8-19, moderate; or 20-35, severe. In each group, the 24- and 48-hr scores were compared with preoperative baseline scores and changes from the preoperative baseline scores were recorded. Isolated direct and indirect hernia and unilateral and bilateral hernia were compared. Descriptive statistics, Student’s t- test, multiple regression, and repeated measures were used to compare outcomes. All patients received inhalational general anesthesia, with only minimal variation in anesthetic agents. Most received rocuronium +/-succinylcholine and reversal of neostigmine with glycopyrrolate +/- atropine. One surgeon performed all the surgeries. RESULTS: Overall, at 24 hr after surgery, the AUASS change from baseline increased significantly, indicating an overall worsening of urinary symptoms (p =.0008). At 48 hours, AUASS significantly improved from baseline, from moderate to mild (p=.0332). (Table 1) Multiple regression analysis showed no significant relationship existed between age and change in score from baseline to 48-hr. No significant difference occurred in changes in AUASS from baseline to 24- and 48-hr between isolated direct and indirect hernia repair, nor between bilateral and unilateral TAPP inguinal hernia repair. No patients required urinary catherization.
| n | baseline | 24 hr | Δ at 24 hr | 48 hr | Δ at 48 hr | |||
| Hernia overall | 134 | 8.2 ± 6.6 moderate | 10.8 ± 8.0 moderate | 2.6 | 6.9 ± 7.2 mild | -1.3 | ||
| Bilateral | 27 | 8.8 ± 7.1 moderate | 11.7 ± 9.6 moderate | 2.9 | 8 ± 8.8 moderate | -.8 | ||
| Unilateral | 107 | 8 ± 6.5 moderate | 10.6 ± 7.6 moderate | 2.6 | 6.7 +/- 6.8 mild | -1.3 | ||
| Direct | 35 | 8 ± 6.8 moderate | 10.5 ± 8.2 moderate | 2.5 | 7.4 ± 7.7 mild | -.6 | ||
| Indirect | 39 | 8.3 ± 6 moderate | 9.6 ± 6.8 moderate | 1.3 | 6.1 ± 5.8 mld | -2.2 |
CONCLUSION: The AUASS significantly increased at 24-hr for TAPP inguinal hernia repairs, indicating a worsening of symptoms. At 48 hours, symptoms significantly improved from baseline, moderate to mild. The AUASS is a useful and sensitive tool to compare postoperative urinary symptoms in TAPP inguinal hernia repair.
Session Number: SS04 – Quality Outcomes
Program Number: S023