Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias

DeLong, Colin G.; Doble, Justin A.; Schilling, Amber; Pauli, Eric M.; Soybel, David I.

doi:10.1016/j.amjsurg.2018.01.030

Cited by 12 publications

(8 citation statements)

References 30 publications

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“…Although the cost associated with specific postherniorrhaphy chronic pain is not well quantified, a 2008 estimate of the annual cost to society of common chronic pain conditions in the US, including postoperative pain, was conservatively estimated to be in the range of $560 billion to $635 billion . Furthermore, chronic postherniorrhaphy pain may contribute to new, persistent opioid use, decreased patient satisfaction, and a substantial health care resource use burden in terms of telephone calls to surgeons, unscheduled clinic visits, and emergency department visits …”

Section: Introductionmentioning

confidence: 99%

“…3 Furthermore, chronic postherniorrhaphy pain may contribute to new, persistent opioid use, 4 decreased patient satisfaction, 2 and a substantial health care resource use burden in terms of telephone calls to surgeons, unscheduled clinic visits, and emergency department visits. 5 Many versions of permanent synthetic mesh are currently available, and the potential correlation of mesh properties with chronic pain indicates a need for a better understanding of that relationship. Although standard heavy-weight polypropylene mesh significantly decreases the risk of hernia recurrence, 6 its usual configuration has rendered it capable of withstanding a force of 6 to 10 times the calculated tensile strength of the average abdominal wall, suggesting that it is overengineered to a supratherapeutic strength.…”

mentioning

confidence: 99%

“…7,8 Its use is also associated with a significant risk of long-term complications, 9 notably an 8-fold increased risk for developing chronic pain after repair. 5 The decrease of hernia recurrence rates related to the use of mesh has given way to a more contemporary but nonetheless impactful measure of success after incisional herniorrhaphy in terms of postoperative quality of life and pain. 10,11 By decreasing the overall amount of foreign-body material and presumably therefore the amount of associated unorganized or reactive scar formation, reduced-weight meshes have been developed as a means to leverage the excessive strength of standard heavy-weight polypropylene, while improving adherence and therefore theoretically improving the risk of chronic postoperative pain.…”

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confidence: 99%

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Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

et al. 2021

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IMPORTANCEAlthough multiple versions of polypropylene mesh devices are currently available on the market for hernia repair, few comparisons exist to guide surgeons as to which device may be preferable for certain indications. Mesh density is believed to impact patient outcomes, including rates of chronic pain and perception of mesh in the abdominal wall.OBJECTIVE To examine whether medium-weight polypropylene is associated with less pain at 1 year compared with heavy-weight mesh. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial was performed from March 14, 2017, to April 17, 2019, with 1-year follow-up. Patients undergoing clean, open ventral hernia repairs with a width 20 cm or less were studied. Patients were blinded to the intervention. INTERVENTIONS Patients were randomized to receive medium-weight or heavy-weight polypropylene mesh during open ventral hernia repair. MAIN OUTCOMES AND MEASURES The primary outcome was pain measured with the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a. Secondary outcomes included quality of life and pain measured at 30 days, quality of life measured at 1 year, 30-day postoperative morbidity, and 1-year hernia recurrence. RESULTS A total of 350 patients participated in the study, with 173 randomized to receive heavy-weight polypropylene mesh (84 [48.6%] female; mean [SD] age, 59.2 [11.4] years) and 177 randomized to receive medium-weight polypropylene mesh (91 [51.4%] female; mean [SD] age, 59.3 [11.4] years). No significant differences were found in demographic characteristics (mean [SD] body mass index of 32.0 [5.4] in both groups [calculated as weight in kilograms divided by height in meters squared] and American Society of Anesthesiologists classes of 2-4 in both groups), comorbidities (122 [70.5%] vs 93 [52.5%] with hypertension, 44 [25.4%] vs 43 [24.3%] with diabetes, 17 [9.8%] vs 12 [6.8%] with chronic obstructive pulmonary disease), or operative characteristics (modified hernia grade of 2 in 130 [75.1] vs 140 [79.1] in the heavy-weight vs medium-weight mesh groups). Pain scores for patients in the heavy-weight vs medium-weight mesh groups at 30 days (46.3 vs 46.3, P = .89) and 1 year (30.7 vs 30.7, P = .59) were identical. No significant differences in quality of life (median [interquartile range] hernia-specific quality of life score at 1 year of 90.0 [67.9-96.7] vs 86.7 [65.0-93.3]; median [interquartile range] hernia-specific quality of life score at 30 days, 45.0 [24.6-73.8] vs 43.3 [28.3-65.0]) were found for the heavy-weight mesh vs medium-weight mesh groups. Composite 1-year recurrence rates for patients in the heavy-weight vs medium-weight polypropylene groups were similar (8% vs 7%, P = .79).CONCLUSIONS AND RELEVANCE Medium-weight polypropylene did not demonstrate any patient-perceived or clinical benefit over heavy-weight polypropylene after open retromuscular ventral hernia repair. Long-term follow-up of these comparable groups will elucidate a...

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

et al. 2021

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“…Most patients complained about post-operative pain to nurses. A cohort study through patients' record in post-operative patients undergoing open repair of complex ventral hernias suggested that the patients still have complaints of pain during the first year after the surgery [10]. The type of pain in post herniotomy patients is moderate pain of shorter duration.…”

Section: Introductionmentioning

confidence: 99%

The effect of warm compress intervention on post herniotomy pain

Cahyaningsih¹,

Savitri

Prasojo³

2020

PSHMS

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The most complaint symptom for post herniotomy patients is pain on the surgical site. Pain may affect patients' ability to mobilize and may attribute to prolonged length of stay in the hospital. Many complementary therapies have been used to decrease pain intensity for patients post-surgery, but warm compress intervention on post herniotomy pain has not been explored significantly. To investigate the effect of warm compress intervention on post herniotomy pain. The study used a pre-post test quasi-experimental with control group design. Sixteen post herniotomy adult patients of Wates Kulon Progo District General Hospital of Yogyakarta were recruited for each group. The intervention group was given warm compress interventions two times per day for two days. Pain intensity was assessed pre and post-intervention with the Numerical Rating Scale, while the control group only received regular analgetic. The researchers used the Wilcoxon Signed-Rank Test and Mann-Whitney U Test to compare pain intensity in each group and between groups.Fifteen out of 16 patients who received warm compress intervention rated decreased pain intensity as the rest did not experience any differences after the intervention (Z=-3.354, p=.001). Unlike the control group, only 3 out of 16 patients experienced declined pain intensity after two days of herniotomy when the rest did not encounter any changes (Z=-1.732, p=.083). The mean rank between intervention and control groups were significantly different (U=20.000, p=.000). Warm compress intervention is a non-invasive nursing intervention which is effective in reducing the pain intensity of post herniotomy patients.

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“…Despite these successes, VHs still have a significant impact on morbidity, healthcare costs, and quality of life. 7,8 Patients experience significant postoperative pain 9 leading to decreased activity levels 10 and increased hospital length of stays (LOS). 11 Recent studies have aimed to identify and mitigate factors associated with postoperative pain, including location of mesh placement, 4 combinations of suture and mesh techniques, 7 preoperative identification of high-risk patients, 12 and the use of fibrin fixation for mesh placement.…”

Section: Introductionmentioning

confidence: 99%

Retromuscular Mesh Repair Using Fibrin Glue: Early Outcomes and Cost-effectiveness of an Evolving Technique

Rhemtulla

Tecce

Broach

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Retromuscular hernia repairs (RHRs) decrease hernia recurrence and surgical site infections but can cause significant pain. We aimed to determine if pain and postoperative outcomes differed when comparing suture fixation (SF) of mesh to fibrin glue fixation (FGF). Methods: Patients undergoing RHR (n = 87) between December 1, 2015 and December 31, 2017 were retrospectively identified. Patients received SF of mesh (n = 59, 67.8%) before the senior author changing his technique to FGF (n = 28, 32.2%). These 2 cohorts were matched (age, body mass index, number of prior repairs, mesh type, defect size, and wound class). Outcomes were analyzed using a matched pairs design with multivariable linear regression. Results: Two matched groups (21 FGF and 21 SF) were analyzed (45.2% female, average age 56 years, average body mass index 34.7 kg/m 2 , and average defect size 330 cm 2 ). Statistical significance was observed for FGF compared with SF: length of stay (3.7 versus 7.1 days, P = 0.032), time with a drain (17.2 versus 27.5 days, P = 0.012), 30-day postoperative visits (2 versus 3, P = 0.003), pain scores (5.2 versus 3.1, P = 0.019) and activity within the first 24 hours (walking versus sitting, P = 0.002). Operative time decreased by 23.1 minutes ( P = 0.352) and postoperative narcotic represcription (3 versus. 8 patients, p=0.147) also decreased. Average cost for patients receiving SF was $36,152 compared to $21,782 for FGF ( P = 0.035). Conclusions: Sutureless RHR using FGF may result in decreased pain when compared with a matched cohort receiving SF, translating to enhanced recovery time, shortened hospital stay, and decreased costs.

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Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias

Cited by 12 publications

References 30 publications

Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

The effect of warm compress intervention on post herniotomy pain

Retromuscular Mesh Repair Using Fibrin Glue: Early Outcomes and Cost-effectiveness of an Evolving Technique

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