Long Term Patterns and Predictors of Pain Following Laparoscopic Inguinal Hernia Repair: A Patient Centered Analysis

Lava Y Patel, Matthew Gitelis, Craig Brown, Brittany Lapin, John Linn, Michael Ujiki, Woody Denham. Northshore University Health System

Introduction:  Laparoscopic inguinal hernia repair (LIHR) has been shown to offer patients the benefit of less pain post-operatively as compared to traditional open techniques. However small, the risk of  prolonged post-operative pain may affect patients decision making.  The aim of this study is to use patient centered assessment tools to elucidate potential patterns of pain and the predictors of such, up to 2 years post-operatively, in order to guide patient expectations.

Methods: We prospectively evaluated 467 patients who underwent totally extra-peritoneal LIHR from March 2009 – June 2015 in an IRB-approved study. Short form-36 (SF36), Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale tools were administered pre- and post-operatively at 3 weeks, 6 months, 1 year and 2 years. Significant pain was determined if a patient indicated mild but bothersome pain or worse.  Changes over time were analyzed using ANOVA, tool assessment comparisons were made using Pearson correlation coefficient, and predictors of significant pain were determined by univariate logistic regression models at p<0.05.

Results: 436 patients underwent a LIHR and completed an assessment tool.  Mean age was 60 (±15) years, with 92% male. Pain improved significantly over time for all tools (p<0.01) although pain was slightly elevated at year 2 on CCS and SOMS. 135 (51%) patients reported significant pain at 3 weeks, 18 (21%) at 6 months, 28 (21%) at 1 year, and 37 (32%) at 2 years.  Reported pain was highly correlated across assessment tools at 3 weeks (p<0.01 for all comparisons), but at 6 months, only SOMS and CCS were significantly correlated. Tools did not correlate at 1 year and 2 years.  After evaluating several patient and procedure characteristics, only general quality of life measurements were predictive of pain at 6 months, 1 year and 2 year.

Conclusions: Our study found reported pain by 51% of patients at 3 weeks with significant improvement by 6 months. Low quality of life and general health were the only predictors of pain after 6 months.  Significant pain is reported at 3 weeks following surgery, but pain after 6 months is unrelated to surgery and due to the patients general health.

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