Impact of opioid use on outcomes after laparoscopic ventral hernia repair

Bruce Ramshaw¹, Jonathan Dean², Andrew Gamenthaler², Michael Fabian². ¹University of Tennessee, Knoxville, ²Halifax Health

Opioid use has become a prevalent issue in our society and therefore many patients who undergo elective surgery are taking opioids pre-operatively for pain management.  To assess the impact of patients who had pre-operative opioid use vs. those who were opioid naive, a data analysis was performed from a prospectively collected clinical quality improvement (CQI) dataset of 109 patients who underwent laparoscopic ventral hernia repair between 6/2012 and 3/2015 (33 months).

There were 28 patients (26%) who were taking opioid medications for pain and 81 patients (74%) who were opioid naïve pre-operatively.  In the opioid group, the average age was 58.6 years (37-85), BMI was 35.0 (22.9-57.6) and the number of recurrent hernias was 19/28 (67.9%).  For patients who were not taking opioids, the average age was 59.3 years (21-93), BMI was 35.9 (18.0-62.4) and the number of recurrent hernias was 40/81 (49.4%). 

During this time period for this analysis, attempts at process improvement for pain management included the addition of multi-modal peri-operative pain management with transversus abdominus plane (TAP) and intraoperative blocks using long-acting local anesthetic to address somatic pain and a low pressure pneumoperitoneum system to address visceral pain.

For the opioid group, OR time was 135.6 minutes (38-294), length of stay was 4.4 days (0-17), average PACU morphine equivalent use was 13.0 (0-43.3) and average total morphine equivalent use was 242.5 (0-1714.1).  For the non-opioid group, average OR time was 133.0 minutes (41-418), length of stay was 3.4 days (0-19), average PACU morphine equivalent use was 8.1 (0-18.3) and average total morphine equivalent use was 90.2 (0-546.6).

In this group of patients who underwent a laparoscopic ventral hernia repair, pre-operative opioid use was associated with a longer length of stay, and increased PACU and total opioid use post-operatively.