Trenton Kinnear, MD, Lauren Grimsley, MD, Brandie Forman, Nikita Shokur, Vince Vetrano, Bruce Ramshaw, MD. UT Medical Center Knoxville
Background: Traditional methods of clinical research may not be adequate to improve the value of care for patients with complex medical problems such as chronic pain after inguinal hernia repair. This problem is very complex with many potential factors contributing to the development of this complication.
Methods: We have implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain (inguinodynia) after inguinal hernia repair. Between April 2011–January 2017, 104 patients underwent 105 operations in an attempt to relieve pain. Patients who had prior laparoscopic inguinal hernia repair had their procedure completed either laparoscopically with mesh removal and neurolysis or a combination of a laparoscopic and open procedure (mesh removal, neurectomy and primary reconstruction of the groin) in an attempt to relieve pain. Some patients received an intraoperative block laparoscopically while another group of patients received an intraoperative block via an open procedure. This evaluation of outcomes was intended to investigate whether there are differences in outcomes depending on whether the patient received a laparoscopic or an open nerve block.
Results: Fifty-nine patients received an intraoperative block for inguinodynia. Of those fifty-nine patients, twenty-three patients had intraoperative blocks laparoscopically and thirty-six patients had an open intraoperative nerve block. Of those twenty-three laparoscopic patients, 43% (10 of 23) had no pain immediately after surgery while 41% (15 of 36) of the open patients had no pain after surgery. The average OR time for the open procedure was 124 minutes while the laparoscopic procedure was 120 minutes averaged. The average post anesthesia care unit time for the open group of patients was 68 minutes while the laparoscopic group of patients had an average time of 51 minutes in the PACU. For the laparoscopic group of patients, 91% (21 of 23) patients were discharged the same day as their procedure. For the open group of patients, 72% (26 of 36) patients were discharged the same day as their procedure.
Discussion: These results suggest the patients who received an intraoperative block laparoscopically were more likely to be able to spend less time in the post anesthesia care unit and be discharged home the same day. Based on these results, additional process improvement ideas will be implemented in an attempt to improve outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88224
Program Number: P365
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster