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Perioperative factors associated with pain following open ventral hernia repair

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Abstract

Background

Effective pain control following open ventral and incisional hernia repair (VHR) impacts all aspects of patient recovery. To reduce opioid use and enhance pain management, multimodal therapy is thought to be beneficial. The purpose of this study was to identify patient characteristics associated with perioperative patient-reported pain scores.

Methods

With IRB approval, surgical databases were searched for cases of open VHR performed over 3 years. Based on a retrospective chart review, modes of pain management and visual analog scale (VAS) pain scores were recorded in 12-h intervals to hospital discharge or to 8 days post-operation. Forward stepwise multivariable regression assessed the independent contribution of the perioperative factors to VAS pain scores.

Results

Included in the analyses were 175 patients that underwent VHR. Average age was 55 years (+/− 12.8), and half were female (50.9%). Factors independently associated with increased preoperative VAS pain scores included preoperative opioid use, preoperative open wound, CDC Wound Class II, and prior hernia repair(s). Patients with epidural for postoperative pain had significantly decreased VAS pain scores across the time continuum. Operative factors significantly associated with increased preoperative VAS pain score included median hernia defect size, concomitantly performed procedure(s), duration of operation, and estimated blood loss. Greater preoperative VAS pain score predicted increased pain at each postoperative time point (all p < .05).

Conclusions

Preoperative pain and opioid use are associated with increased pain postoperatively. Epidural analgesia effectively results in decreased patient-reported pain. Increased operative complexity is associated with increased preoperative pain scores.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA

    Margaret A. Plymale & John Scott Roth

  2. University of Kentucky College of Medicine, Lexington, KY, USA

    Walker Ueland

  3. Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA

    Daniel L. Davenport

Authors
  1. Walker Ueland
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  2. Margaret A. Plymale
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Corresponding author

Correspondence to Margaret A. Plymale.

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Disclosures

Walker Ueland, Margaret Plymale, and Daniel Davenport declare no conflicts of interest. John Scott Roth declares conflict of interest not directly related to the submitted work: grants, personal fees, and other from Bard; grants, personal fees, and other from Acelity; and grants from Miromatrix.

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Ueland, W., Plymale, M.A., Davenport, D.L. et al. Perioperative factors associated with pain following open ventral hernia repair. Surg Endosc 33, 4102–4108 (2019). https://doi.org/10.1007/s00464-019-06713-1

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  • DOI: https://doi.org/10.1007/s00464-019-06713-1

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