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Wilson HH, Ma C, Ku D, Scarola GT, Augenstein VA, Colavita PD, Heniford BT. Deep learning model utilizing clinical data alone outperforms image-based model for hernia recurrence following abdominal wall reconstruction with long-term follow up. Surg Endosc 2024:10.1007/s00464-024-10980-y. [PMID: 38862826 DOI: 10.1007/s00464-024-10980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Deep learning models (DLMs) using preoperative computed tomography (CT) imaging have shown promise in predicting outcomes following abdominal wall reconstruction (AWR), including component separation, wound complications, and pulmonary failure. This study aimed to apply these methods in predicting hernia recurrence and to evaluate if incorporating additional clinical data would improve the DLM's predictive ability. METHODS Patients were identified from a prospectively maintained single-institution database. Those who underwent AWR with available preoperative CTs were included, and those with < 18 months of follow up were excluded. Patients were separated into a training (80%) set and a testing (20%) set. A DLM was trained on the images only, and another DLM was trained on demographics only: age, sex, BMI, diabetes, and history of tobacco use. A mixed-value DLM incorporated data from both. The DLMs were evaluated by the area under the curve (AUC) in predicting recurrence. RESULTS The models evaluated data from 190 AWR patients with a 14.7% recurrence rate after an average follow up of more than 7 years (mean ± SD: 86 ± 39 months; median [Q1, Q3]: 85.4 [56.1, 113.1]). Patients had a mean age of 57.5 ± 12.3 years and were majority (65.8%) female with a BMI of 34.2 ± 7.9 kg/m2. There were 28.9% with diabetes and 16.8% with a history of tobacco use. The AUCs for the imaging DLM, clinical DLM, and combined DLM were 0.500, 0.667, and 0.604, respectively. CONCLUSIONS The clinical-only DLM outperformed both the image-only DLM and the mixed-value DLM in predicting recurrence. While all three models were poorly predictive of recurrence, the clinical-only DLM was the most predictive. These findings may indicate that imaging characteristics are not as useful for predicting recurrence as they have been for other AWR outcomes. Further research should focus on understanding the imaging characteristics that are identified by these DLMs and expanding the demographic information incorporated in the clinical-only DLM to further enhance the predictive ability of this model.
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Affiliation(s)
- Hadley H Wilson
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Chiyu Ma
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Dau Ku
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Gregory T Scarola
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Paul D Colavita
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA.
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Widder A, Reese L, Lock JF, Wiegering A, Germer CT, Rittner HL, Dietz UA, Schlegel N, Meir M. Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment. Hernia 2024:10.1007/s10029-024-03027-7. [PMID: 38526673 DOI: 10.1007/s10029-024-03027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/09/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) is a potential long-term problem following open incisional hernia repair which may affect the quality of life of patients despite successful anatomical repair of the hernia. The aim of this manuscript was to identify the incidence and outcome of patients following open incisional hernia repair in respect of risk factors to develop CPSP. METHODS A single-center retrospective analysis of patients who underwent open incisional hernia repair between 2015 and 2021 was performed. Pre-existing conditions (e.g., diabetes mellitus and malignancy), hernia complexity, postoperative complications, and postoperative pain medication were analyzed using the local database. Quality of life and CPSP were assessed using the EuraHS Quality of Life (QoL) questionnaire. RESULTS A total of 182 cases were retrospectively included in a detailed analysis based on the complete EuraHS (QoL) questionnaire. During the average follow-up period of 46 months, this long-term follow-up revealed a 54.4% incidence of CPSP and including a rate of 14.8% for severe CPSP (sCPSP) after open incisional hernia surgery. The complexity of the hernia and the demographic variables were not different between the group with and without CPSP. Patients with CPSP reported significantly reduced QoL. The analgesics score which includes the need of pain medication in the initial days after surgery was significantly higher in patients with CPSP than in those without (no CPSP: 2.86 vs. CPSP: 3.35; p = 0.047). CONCLUSION The presence of CPSP after open incisional hernia repair represents a frequent and underestimated long-term problem which has been not been recognized to this extent before. CPSP impairs QoL in these patients. Patients at risk to develop CPSP can be identified in the perioperative setting by the need of high doses of pain medication using the analgesics score. Possibly timely adjustment of pain medication, even in the domestic setting, could alleviate the chronicity or severity of CPSP.
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Affiliation(s)
- A Widder
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - L Reese
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Würzburg, Germany
| | - J F Lock
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - A Wiegering
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - C-T Germer
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - H L Rittner
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital of Wuerzburg, Würzburg, Germany
| | - U A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Olten, Switzerland
| | - N Schlegel
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - M Meir
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany.
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Wilson HH, Rose M, Ku D, Scarola GT, Augenstein VA, Colavita PD, Heniford BT. Prospective, international analysis of quality of life outcomes in recurrent versus primary ventral hernia repairs. Am J Surg 2023; 226:803-807. [PMID: 37407392 DOI: 10.1016/j.amjsurg.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Quality of life (QOL) has become a key outcome measure following ventral hernia repair (VHR), but recurrent and primary VHR have not been compared in this context previously. METHODS The International Hernia Mesh Registry (2008-2019) was used to identify patients with QOL data scored by the Carolinas Comfort Scale preoperatively and postoperatively at 1 year. RESULTS Repairs were performed in 227 recurrent and 1,122 primary VHs. Recurrent patients had a higher BMI, larger defects, and were more likely to have preoperative pain, but other comorbidities were equal. Recurrence rates at 1 year were equivalent. Recurrent patients had a greater improvement in pain (-6.3 ± 10.2 vs -4.3 ± 8.3,p = 0.002) and movement limitation (-5.5 ± 10.0 vs -3.2 ± 7.2,p < 0.001) compared to primary patients, but they had increased postoperative mesh sensation (4.6 ± 7.7 vs 2.7 ± 5.5,p < 0.001). CONCLUSIONS Recurrent VHRs led to improved pain and movement limitation, but increased mesh sensation. These findings may be useful for preoperative counseling in the elective setting.
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Affiliation(s)
- Hadley H Wilson
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Mikayla Rose
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Dau Ku
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Gregory T Scarola
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Paul D Colavita
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
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Segelcke D, Rosenberger DC, Pogatzki-Zahn EM. Prognostic models for chronic postsurgical pain-Current developments, trends, and challenges. Curr Opin Anaesthesiol 2023; 36:580-588. [PMID: 37552002 DOI: 10.1097/aco.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW Prognostic models for chronic postsurgical pain (CPSP) aim to predict the likelihood for development and severity of CPSP in individual patients undergoing surgical procedures. Such models might provide valuable information for healthcare providers, allowing them to identify patients at higher risk and implement targeted interventions to prevent or manage CPSP effectively. This review discusses the latest developments of prognostic models for CPSP, their challenges, limitations, and future directions. RECENT FINDINGS Numerous studies have been conducted aiming to develop prognostic models for CPSP using various perioperative factors. These include patient-related factors like demographic variables, preexisting pain conditions, psychosocial aspects, procedure-specific characteristics, perioperative analgesic strategies, postoperative complications and, as indicated most recently, biomarkers. Model generation, however, varies and performance and accuracy differ between prognostic models for several reasons and validation of models is rather scarce. SUMMARY Precise methodology of prognostic model development needs advancements in the field of CPSP. Development of more accurate, validated and refined models in large-scale cohorts is needed to improve reliability and applicability in clinical practice and validation studies are necessary to further refine and improve the performance of prognostic models for CPSP.
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Affiliation(s)
- Daniel Segelcke
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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Christoffersen MW, Henriksen NA. Long-Term Outcomes After Epigastric Hernia Repair in Women-A Nationwide Database Study. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11626. [PMID: 38312415 PMCID: PMC10831641 DOI: 10.3389/jaws.2023.11626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/14/2023] [Indexed: 02/06/2024]
Abstract
Aim: Women have the highest prevalence of epigastric hernia repair. Outcomes after epigastric hernia repair are rarely reported independently, although pathology and surgical techniques may be different than for other primary ventral hernias. The aim of this study was to evaluate long-term outcomes after epigastric hernia repairs in women on a nationwide basis. Methods: Nationwide cohort study from the Danish Hernia Database. Complete data from women undergoing elective epigastric hernia repair during a 12 years period (2007-2018) was extracted. A 100% follow-up was obtained by combining data from the National Civil Register. The primary outcome was operation for recurrence, secondary outcomes were readmission and operation for complications. Outcomes for open sutured repair, open mesh repair mesh, and laparoscopic repairs were compared. Results: In total, 3,031 women underwent elective epigastric hernia repair during the study period. Some 1,671 (55.1%) women underwent open sutured repair, 796 (26.3%) underwent open mesh repair, and 564 (18.6%) underwent laparoscopic repair. Follow-up was median 4.8 years. Operation for recurrence was higher after sutured repairs than after open mesh and laparoscopic repairs (7.7% vs. 3.3%, vs. 6.2%, p < 0.001). The risk of operation for complications was slightly higher after open mesh repair compared with sutured repair and laparoscopic repair (2.6% vs. 1.2%, vs. 2.0%, p = 0.032), with more operations for wound complications in the open mesh group (2.0%, p = 0.006). Conclusion: More than half of the women underwent a suture-based repair, although mesh repair reduces risk of recurrence. Open mesh repair had the lowest risk of recurrence, but on the expense of slightly increased risk of wound-related complications.
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Affiliation(s)
- M. W. Christoffersen
- Digestive Disease Center, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - N. A. Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Frey S, Beauvais A, Soler M, Beck M, Dugué T, Pavis d'Escurac X, Dabrowski A, Jurczak F, Gillion JF. Suture versus open mesh repair for small umbilical hernia: Results of a propensity-matched cohort study. Surgery 2023; 174:593-601. [PMID: 37357098 DOI: 10.1016/j.surg.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes. METHODS This propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11. RESULTS Mesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients. CONCLUSION Both techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.
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Affiliation(s)
- Samuel Frey
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France.
| | | | - Marc Soler
- Service de chirurgie viscérale et digestive, Clinique Saint-Jean, Cagnes-sur-Mer, France
| | | | - Timothée Dugué
- Service de chirurgie viscérale et digestive, Clinique Saint Pierre, Perpignan, France
| | | | - André Dabrowski
- Service de chirurgie viscérale et digestive, Clinique de Saint-Omer, Blendecques, France
| | - Florent Jurczak
- Service de chirurgie digestive et viscérale, Clinique Mutualiste de l'Estuaire, Saint-Nazaire, France
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Oliveira ESC, Calvi IP, Hora DAB, Gomes CP, Burlá MM, Mao RMD, de Figueiredo SMP, Lu R. Impact of sex on ventral hernia repair outcomes: A systematic review and meta-analysis. Am J Surg 2023; 226:385-392. [PMID: 37394348 DOI: 10.1016/j.amjsurg.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Given the variability in abdominal physiology and hernia presentation between sexes, better comprehension of sex-related differences in outcomes would tailor surgical approach and counseling regarding postoperative outcomes. This meta-analysis aims to appraise the effect of sex on the outcomes of ventral hernia repair. METHODS A literature search in PubMed, EMBASE and Cochrane selected studies comparing outcomes of ventral hernia repair between sexes. Postoperative outcomes were assessed by pooled and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS We screened 3128 studies, reviewed 133, and included 18 observational studies, which encompassed 220,799 patients following ventral hernia repair. Postoperative chronic pain was significantly higher in female (OR 1,9; 95% CI 1,64-2,2; p < 0,001). There were no significant differences in complications, readmission, or recurrence rates between females and males. CONCLUSION Female sex is associated with a higher risk of postoperative chronic pain following ventral hernia repair.
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Affiliation(s)
| | - Izabela P Calvi
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad Oblast, Russian Federation
| | - David A B Hora
- Division of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Cintia P Gomes
- Division of Obstetrics and Gynecology, Maimonides Medical Center, New York City, New York, United States
| | - Marina M Burlá
- Division of Medicine, Estácio de Sá Vista Carioca University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rui-Min Diana Mao
- Division of General Surgery, University of Texas Medical Branch, Galveston, TX, United States
| | | | - Richard Lu
- Division of General Surgery, University of Texas Medical Branch, Galveston, TX, United States
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Li J, Shao X, Cheng T. Comparison of Different Weight Meshes in Ventral/Incisional Hernia Repair, the Outcomes of Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2023; 33:402-410. [PMID: 37311039 DOI: 10.1097/sle.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The use of mesh is not without complications. Decreasing the mesh weight with the light-weight (LW) mesh may improve tissue growth and diminish mesh-related complications, yet, clinically, there are conflicting results regarding the influence of different weight meshes in ventral/incisional hernia repair. The aim of the present study is to compare the outcomes of different weight meshes for ventral/incisional hernia repair. METHODS The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies were published through January 1, 2022, using the keywords "heavy weight" "light weight" "mesh" "ventral hernia" "incisional hernia". All relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS Eight trials (4 randomized controlled trials, 3 prospective studies, and 1 retrospective study) containing 1844 patients were included in the present meta-analysis. The pooled results showed that there was a significantly more rate of foreign body perception in the heavy-weight mesh group compared with the LW mesh group (odds ratio = 5.02, 95% CI: 1.05, 24.06). There was no significant difference concerning hernia recurrence, seroma, hematoma, surgical site infection, reoperation rate, chronic pain, quality of life, and hospital stay among different weight mesh groups. CONCLUSION Different weight meshes showed similar clinical results in ventral/incisional hernia repair, except that, perception of foreign body was reported more frequently in the heavy-weight mesh group as compared with the LW mesh group. However, the long-term hernia recurrence with different weights of meshes needs to be reevaluated considering the relative short-term follow-up in these studies.
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Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
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Hoffmann H, Mechera R, Nowakowski D, Adolf D, Kirchhoff P, Riediger H, Köckerling F. Gender differences in epigastric hernia repair: a propensity score matching analysis of 15,925 patients from the Herniamed registry. Hernia 2023:10.1007/s10029-023-02799-8. [PMID: 37160505 DOI: 10.1007/s10029-023-02799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION In recent surgical literature, gender-specific differences in the outcome of hernia surgery has been analyzed. We already know that female patients are at higher risk to develop chronic postoperative pain after inguinal, incisional, and umbilical hernia surgery. In this study, we evaluated the impact of gender on the outcome after epigastric hernia surgery. METHODS A covariable-adjusted matched-paired analysis with data derived from the Herniamed registry was performed. In total of 15,925 patients with 1-year follow-up data were included in the study. Propensity score matching was performed for the 7786 female (48.9%) and 8139 male (51.1%) patients, creating 6350 pairs (81.6%). RESULTS Matched-paired analysis revealed a significant disadvantage for female patients for pain on exertion (12.1% vs. 7.6%; p < 0.001) compared to male patients. The same effect was demonstrated for pain at rest (6.2% in female patients vs. 4.1% in male patients; p < 0.001) and pain requiring treatment (4.6% in female patients vs. 3.1% in male patients; p < 0.001). All other outcome parameters showed no significant differences between female and male patients. CONCLUSIONS Female patients are at a higher risk for chronic pain after elective epigastric hernia repairs compared to the male patient population. These results complete findings of previous studies showing the same effect in inguinal, umbilical, and incisional hernia repair.
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Affiliation(s)
- H Hoffmann
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns Vorstadt 44, 4056, Basel, Switzerland.
- Clinic for Orthopedics and Surgery, Merian Iselin Clinic, Basel, Switzerland.
| | - R Mechera
- Breast and Endocrine Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
| | - D Nowakowski
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns Vorstadt 44, 4056, Basel, Switzerland
- Clinic for Orthopedics and Surgery, Merian Iselin Clinic, Basel, Switzerland
| | - D Adolf
- StatConsult, Magdeburg, Germany
| | - P Kirchhoff
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns Vorstadt 44, 4056, Basel, Switzerland
- Clinic for Orthopedics and Surgery, Merian Iselin Clinic, Basel, Switzerland
| | - H Riediger
- Center for Hernia Surgery, Vivantes Humboldt Clinic, Berlin, Germany
| | - F Köckerling
- Center for Hernia Surgery, Vivantes Humboldt Clinic, Berlin, Germany
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Zou Z, Zhang D, Liu Y, Wang M. Postoperative compression in preventing early complications after groin hernia repair. Hernia 2023:10.1007/s10029-023-02752-9. [PMID: 36808493 DOI: 10.1007/s10029-023-02752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/29/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE We conducted this study to investigate the efficacy, safety, and clinical value of postoperative compression in preventing seroma formation, relieving acute pain, and improving QoL after groin hernia repair. METHODS This multi-center, prospective, observational real-world study was conducted from March 1, 2022, to August 31, 2022. The study was completed in 53 hospitals in 25 provinces in China. A total of 497 patients who underwent groin hernia repair were enrolled. All patients used a compression device to compress the operative region after surgery. The primary outcome was seroma incidence 1 month after surgery. Secondary outcomes included postoperative acute pain and QoL. RESULTS A total of 497 patients [median (IQR) age 55 (41-67) years, 456 (91.8%) male] were enrolled, of whom 454 underwent laparoscopic groin hernia repair and 43 open hernia repair. The follow-up rate was 98.4% 1 month after surgery. Seroma incidence was 7.2% (35 of 489 patients) overall, lower than reported by previous research. No significant differences were found between the two groups (P > 0.05). VAS scores after compression were significantly lower than before compression overall and in both groups (P < 0.001). The laparoscopic group showed a high level of QoL compared with the open group, but there was no significant difference between the two groups (P > 0.05). CCS score correlated positively with VAS score. CONCLUSION Postoperative compression, to a certain extent, can reduce seroma incidence, relieve postoperative acute pain, and improve QoL after groin hernia repair. Further large-scale randomized controlled studies are warranted to determine long-term outcomes.
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Affiliation(s)
- Zhenyu Zou
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Dingyuan Zhang
- Department of Medical Affairs, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yuchen Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
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Lindmark M, Löwenmark T, Strigård K, Gunnarsson U. Major complications and mortality after ventral hernia repair: an eleven-year Swedish nationwide cohort study. BMC Surg 2022; 22:426. [PMID: 36514042 DOI: 10.1186/s12893-022-01873-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIMS Ventral hernia repair is one of the most common surgical procedures performed worldwide. Despite the large volume, consensus is lacking regarding indications for repair or choice of surgical method used for reconstruction. The aim of this study was to explore the risk for major complications and mortality in ventral hernia repair using data from a nationwide patient register. METHOD Patient data of individuals over 18 years of age who had a ventral hernia procedure between 2004 and 2014 were retrieved from the Patient Register kept by the Swedish National Board of Health and Welfare. After exclusion of patients with concomitant bowel surgery, 45 676 primary surgical admissions were included. Procedures were dichotomised into laparoscopic and open surgery, and stratified for primary and incisional hernias. RESULTS A total of 45 676 admissions were analysed. The material comprised 36% (16 670) incisional hernias and 64% (29 006) primary hernias. Women had a higher risk for reoperation during index admission after primary hernia repair (OR 1.84 (1.29-2.62)). Forty-three patients died of complications within 30 days of index surgery. Patients aged 80 years and older had a 2.5 times higher risk for a complication leading to reoperation, and a 12-fold higher mortality risk than patients aged 70-79 years. CONCLUSION Age is the dominant mortality risk factor in ventral hernia repair. Laparoscopic surgery was associated with a lower risk for reoperation during index admission. Reoperation seems to be a valid outcome variable, while registration of complications is generally poor in this type of cohort.
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Affiliation(s)
- Mikael Lindmark
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Thyra Löwenmark
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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12
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Evaluation of Treatment Differences Between Men and Women Undergoing Ventral Hernia Repair: An Analysis of the Abdominal Core Health Quality Collaborative. J Am Coll Surg 2022; 235:603-611. [PMID: 36106866 DOI: 10.1097/xcs.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sex is emerging as an important clinical variable associated with surgical outcomes and decision making. However, its relevance in regard to baseline and treatment differences in primary and incisional ventral hernia repair remains unclear. STUDY DESIGN This is a retrospective cohort study using the Abdominal Core Health Quality Collaborative database to identify elective umbilical, epigastric, or incisional hernia repairs. Propensity matching was performed to investigate confounder-adjusted treatment differences between men and women. Treatments of interest included surgical approach (minimally invasive or open), mesh use, mesh type, mesh position, anesthesia type, myofascial release, fascial closure, and fixation use. RESULTS A total of 8,489 umbilical, 1,801 epigastric, and 16,626 incisional hernia repairs were identified. Women undergoing primary ventral hernia repair were younger (umbilical 46.4 vs 54 years, epigastric 48.7 vs 52.7 years), with lower BMI (umbilical 30.4 vs 31.5, epigastric 29.2 vs 31.1), and less likely diabetic (umbilical 9.9% vs 11.4%, epigastric 6.8% vs 8.8%). Women undergoing incisional hernia repair were also younger (mean 57.5 vs 59.1 years), but with higher BMI (33.1 vs 31.5), and more likely diabetic (21.4% vs 19.1%). Propensity-matched analysis included 3,644 umbilical, 1,232 epigastric, and 12,480 incisional hernias. Women with incisional hernia were less likely to undergo an open repair (60.2% vs 63.4%, p < 0.001) and have mesh used (93.8% vs 94.8%, p = 0.02). In umbilical and incisional hernia repairs, women had higher rates of intraperitoneal mesh placement and men had higher rates of preperitoneal and retro-muscular mesh placement. CONCLUSIONS Small but statistically significant treatment differences in operative approach, mesh use, and mesh position exist between men and women undergoing ventral hernia repair. It remains unknown whether these treatment differences result in differing clinical outcomes.
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13
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Howard R, Ehlers A, Delaney L, Solano Q, Shen M, Englesbe M, Dimick J, Telem D. Sex disparities in the treatment and outcomes of ventral and incisional hernia repair. Surg Endosc 2022; 37:3061-3068. [PMID: 35920905 DOI: 10.1007/s00464-022-09475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite females accounting for nearly half of ventral and incisional hernia repairs performed each year in the United States, shockingly little attention has been paid to sex disparities in hernia treatment and outcomes. We explored sex-based differences in operative approach and outcomes using a population-level hernia registry. METHODS We performed a retrospective review of the Michigan Surgical Quality Collaborative Hernia Registry (MSQC-HR) to identify patients undergoing clean ventral or incisional hernia repair between January 1, 2020 to December 31, 2021. The primary outcomes were risk-adjusted rates of laparoscopic/robotic approach, mesh use, and composite 30-day adverse events stratified by sex. Risk adjustment between sex was performed using all patient, clinical, and hernia characteristics. RESULTS 5269 patients underwent ventral and incisional hernia repair of whom 2295 (43.6%) patients were female. Mean age was 53.9 (14.5) years. Females had slightly larger hernias (3.5 cm vs. 3.0 cm, P < 0.001), fewer umbilical hernias (50.9% vs. 73.0%, P < 0.001), and a higher prevalence of prior hernia repair (17.9% vs. 13.4%, P < 0.001). In a multivariable logistic regression adjusting for differences between males and females, female sex was associated with lower odds of mesh use [aOR 0.62 (95% CI 0.52-0.74)] and higher odds of laparoscopic/robotic repair [aOR 1.26 (95% CI 1.10-1.44)]. In a similar multivariable model, female sex was also associated with significantly higher odds of composite 30-day adverse events [aOR 1.64 (95% CI 1.32-2.02)]. This equates to predicted probabilities of 11.7% (95% CI 10.3-13.0%) vs. 7.6% (95% CI 6.6-8.6%) for adverse events in females compared to males. CONCLUSIONS Despite being younger and having fewer comorbidities, women were more likely to experience adverse events after surgery. Moreover, women were less likely to have mesh placed. Additional work is needed to understand the factors that drive these gender disparities in ventral hernia treatment and outcomes.
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Affiliation(s)
- Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Anne Ehlers
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Lia Delaney
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Quintin Solano
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mary Shen
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Michael Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA
| | - Justin Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Division of Minimally Invasive Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA
| | - Dana Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
- Division of Minimally Invasive Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA.
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14
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Parseliunas A, Paskauskas S, Simatoniene V, Vaitekunas J, Venskutonis D. Adaptation and validation of the Carolinas Comfort Scale: a questionnaire-based cross-sectional study. Hernia 2022; 26:735-744. [PMID: 33782789 PMCID: PMC9200669 DOI: 10.1007/s10029-021-02399-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Quality of life (QoL) is an important outcome following surgery. The Carolinas Comfort scale (CCS) is a specific questionnaire used to evaluate QoL in patients who underwent abdominal hernia repair with mesh. The aim of this study was to create a Lithuanian version of the CCS. METHODS A questionnaire-based cross-sectional study was conducted. A Lithuanian version of the CCS was created by translating the original questionnaire in accordance with the guidelines. The Lithuanian questionnaire was provided to hernia patients at 1 week and at 1 month postoperatively. The main validation characteristics of the Lithuanian CCS were assessed and compared to the original version. RESULTS The complete response rate of patients was close to 90%. Internal consistency was excellent, with a Cronbach's α of 0.953. Correlation coefficients ranged from 0.361 to 0.703 in the test-retest analysis. In the construct validity analysis, the strongest correlations were observed in the domains of physical functioning and bodily pain (- 0.655 and - 0.584, respectively) and the weakest correlations in role-emotional and mental health (- 0.268 and - 0.230, respectively). The mean scores of all CCS domains and the total score for satisfied patients were significantly lower (p < 0.001) than those of dissatisfied patients. The principal component analysis identified 3 components, with the first accounting for 56% of the variance. CONCLUSIONS The Lithuanian version of CCS maintains the original validity and is a reliable and valid tool for assessing specific QoL factors after the repair of inguinal hernia with mesh. We recommend using this CCS version in personal, local, and international contexts.
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Affiliation(s)
- A Parseliunas
- Department of General Surgery, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania.
| | - S Paskauskas
- Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, LT-44307, Lithuania
| | - V Simatoniene
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, LT-44307, Lithuania
| | - J Vaitekunas
- Department of General Surgery, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
| | - D Venskutonis
- Department of General Surgery, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
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15
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Takayama Y, Kaneoka Y, Maeda A, Takahashi T, Seita K. Long-Term Outcomes Using a Questionnaire After Inguinal Hernia Repair in Female. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Papadomanolakis-Pakis N, Uhrbrand P, Haroutounian S, Nikolajsen L. Prognostic prediction models for chronic postsurgical pain in adults: a systematic review. Pain 2021; 162:2644-2657. [PMID: 34652320 DOI: 10.1097/j.pain.0000000000002261] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 12/23/2022]
Abstract
ABSTRACT Chronic postsurgical pain (CPSP) affects an estimated 10% to 50% of adults depending on the type of surgical procedure. Clinical prediction models can help clinicians target preventive strategies towards patients at high risk for CPSP. Therefore, the objective of this systematic review was to identify and describe existing prediction models for CPSP in adults. A systematic search was performed in MEDLINE, Embase, PsychINFO, and the Cochrane Database of Systematic Reviews in March 2020 for English peer-reviewed studies that used data collected between 2000 and 2020. Studies that developed, validated, or updated a prediction model in adult patients who underwent any surgical procedure were included. Two reviewers independently screened titles, abstracts, and full texts for eligibility; extracted data; and assessed risk of bias using the Prediction model Risk of Bias Assessment Tool. The search identified 2037 records; 28 articles were reviewed in full text. Fifteen studies reporting on 19 prediction models were included; all were at high risk of bias. Model discrimination, measured by the area under receiver operating curves or c-statistic, ranged from 0.690 to 0.816. The most common predictors identified in final prediction models included preoperative pain in the surgical area, preoperative pain in other areas, age, sex or gender, and acute postsurgical pain. Clinical prediction models may support prevention and management of CPSP, but existing models are at high risk of bias that affects their reliability to inform practice and generalizability to wider populations. Adherence to standardized guidelines for clinical prediction model development is necessary to derive a prediction model of value to clinicians.
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Affiliation(s)
| | - Peter Uhrbrand
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Lone Nikolajsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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17
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Krpata DM, Petro CC, Prabhu AS, Tastaldi L, Zolin S, Fafaj A, Rosenblatt S, Poulose BK, Pierce RA, Warren JA, Carbonell AM, Goldblatt MI, Stewart TG, Olson MA, Rosen MJ. Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair: A Randomized Clinical Trial. JAMA Surg 2021; 156:1085-1092. [PMID: 34524395 DOI: 10.1001/jamasurg.2021.4309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although 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 any potential differences in durability that have yet to be identified. Trial Registration ClinicalTrials.gov Identifier: NCT03082391.
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Affiliation(s)
- David M Krpata
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Clayton C Petro
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Luciano Tastaldi
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sam Zolin
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Richard A Pierce
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Jeremy A Warren
- Department of Surgery, University of South Carolina School of Medicine, Greenville.,Department of Surgery, Prisma Health, Greenville, South Carolina
| | - Alfredo M Carbonell
- Department of Surgery, University of South Carolina School of Medicine, Greenville.,Department of Surgery, Prisma Health, Greenville, South Carolina
| | | | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Molly A Olson
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
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18
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Strategies for Mesh Fixation in Abdominal Wall Reconstruction: Concepts and Techniques. Plast Reconstr Surg 2021; 147:484-491. [PMID: 33235048 DOI: 10.1097/prs.0000000000007584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Ventral hernias have numerous causes, ranging from sequelae of surgical procedures to congenital deformities. Patients suffering from these hernias experience a reduced quality of life through pain, associated complications, and physical disfigurement. Therefore, it is important to provide these patients with a steadfast repair that restores functionality and native anatomy. To do this, techniques and materials for abdominal wall reconstruction have advanced throughout the decades, leading to durable surgical repairs. At the cornerstone of this lies the use of mesh. When providing abdominal wall reconstruction, a surgeon must make many decisions with regard to mesh use. Along with the type of mesh and plane of placement of mesh, a surgeon must decide on the method of mesh fixation. Fixation of mesh provides an equal distribution of tension and a more robust tissue-mesh interface, which promotes integration. There exist numerous modalities for mesh fixation, each with its own benefits and drawbacks. This Special Topic article aims to compare and contrast methods of mesh fixation in terms of strength of fixation, clinical outcomes, and cost-effectiveness. Methods included in this review are suture, tack, fibrin glue, mesh strip, and self-adhering modes of fixation.
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19
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Smith CR, Baharloo R, Nickerson P, Wallace M, Zou B, Fillingim RB, Crispen P, Parvataneni H, Gray C, Prieto H, Machuca T, Hughes S, Murad G, Rashidi P, Tighe PJ. Predicting long-term postsurgical pain by examining the evolution of acute pain. Eur J Pain 2021; 25:624-636. [PMID: 33171546 PMCID: PMC8628519 DOI: 10.1002/ejp.1698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/08/2020] [Indexed: 09/13/2023]
Abstract
BACKGROUND Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage. METHODS We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX-based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other. RESULTS This single-centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the 'None' and 'Severe' outcomes at M1 (cosine similarity 0.44) and M6 (cosine similarity 0.49). Stratifications of M6 outcomes by preoperative pain intensity, sex, age group, surgery type and catastrophising showed significant heterogeneity of pain transition patterns within and across strata. Severe-to-severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6. CONCLUSIONS Clinically, these results suggest that individual pain-state transitions, even within patient or procedural strata associated with PPP, may not alone offer good predictive information regarding PPP. Longitudinal observation in the immediate postoperative period and consideration of patient- and surgery-specific factors may help indicate which patients are at increased risk of PPP. SIGNIFICANCE Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.
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Affiliation(s)
- Cameron R Smith
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Raheleh Baharloo
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
| | - Paul Nickerson
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Margaret Wallace
- Center for NeuroGenetics, University of Florida, Gainesville, FL, USA
| | - Baiming Zou
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Paul Crispen
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hari Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Chancellor Gray
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hernan Prieto
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tiago Machuca
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gregory Murad
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Parisa Rashidi
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Patrick J Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
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20
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Shao JM, Elhage SA, Prasad T, Colavita PD, Augenstein VA, Heniford BT. Outcomes of Laparoscopic-Assisted, Open Umbilical Hernia Repair. Am Surg 2020; 86:1001-1004. [PMID: 32853047 DOI: 10.1177/0003134820942162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Umbilical hernia repair (UHR) is one of the most commonly performed hernia operations with reported recurrence rate from 1% to 54%. Our aim was to describe an open, laparoscopic-assisted (OLA) technique and its outcome in an institutional review board-approved prospective study at a tertiary hernia center from 2008 to 2019. All patients underwent a standard periumbilical incision, open dissection of the hernia, and closure of the fascial defect with laparoscopic intraperitoneal onlay mesh (IPOM) fixation with permanent tacks. A total of 186 patients were identified who underwent an OLA UHR repair. Patient characteristics are as follows: average age 52.8 ± 12.5 years, male gender 79.6%, body mass index 31.4 ± 8.0 kg/m2, and average hernia defect size of 2.8 ± 4.8 cm2. Forty-one (22.0%) patients had previous failed repair. Sixty-nine (37.1%) patients had another procedure performed at the time of the UHR, most commonly a laparoscopic transabdominal inguinal hernia repair (58%). The mean operative time was 87.3 ± 51.2 minutes, but only 63.9 ± 31.9 minutes for patients undergoing an OLA repair. There were no recurrences (0%) on abdominal physical or radiographic examination with an average follow-up of 16.5 ± 17.7 months. Postoperative complications included wound erythema (2.7%), hematomas (1.1%), seromas (2.7%), and 4.3% received postoperative oral antibiotics. One person was readmitted for seroma drainage, and another required reoperation for small bowel obstruction unrelated to the hernia repair. One patient had chronic pain requiring tack removal. With moderate follow-up, an OLA UHR with mesh appears to be a durable repair with favorable results, including those patients with recurrent hernias.
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Affiliation(s)
- Jenny M Shao
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Sharbel A Elhage
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Tanu Prasad
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Paul D Colavita
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
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21
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Schlosser KA, Maloney SR, Thielan O, Prasad T, Kercher K, Colavita PD, Heniford BT, Augenstein VA. Outcomes specific to patient sex after open ventral hernia repair. Surgery 2020; 167:614-619. [DOI: 10.1016/j.surg.2019.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
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22
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Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair. Comput Inform Nurs 2020; 38:227-231. [PMID: 31929356 DOI: 10.1097/cin.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.
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23
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Köckerling F, Hoffmann H, Adolf D, D Weyhe, Reinpold W, Koch A, Kirchhoff P. Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison. Hernia 2019; 24:567-576. [PMID: 31776879 PMCID: PMC7210249 DOI: 10.1007/s10029-019-02089-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022]
Abstract
Introduction To date, little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome. Therefore, there is a sex bias in the surgical literature. With an incidence of more than 20% after 3 years, incisional hernias are a common complication following abdominal surgical procedures. The proportion of women affected is around 50%. There are very few references in the literature to the influence of sex on the outcome of elective incisional hernia repair. Materials and methods In all, 22,895 patients with elective incisional hernia repair from the Herniamed Registry were included in the study. The patients had undergone elective incisional hernia repair in a laparoscopic IPOM, open sublay, open IPOM, open onlay or suture technique. 1-year follow-up was available for all patients. Propensity score matching was performed for the 11,480 female (50.1%) and 11,415 male (49.9%) patients, creating 8138 pairs (82.0%) within fixed surgical procedures. Results For pain on exertion (11.7% vs 18.3%; p < 0.001), pain at rest (7.53% vs 11.1%; p < 0.001), and pain requiring treatment (5.4% vs 9.1%; p < 0.001) highly significant disadvantages were identified for the female sex when comparing the different results within the matched pairs. That was also confirmed on comparing sex within the individual surgical procedures. No sex-specific differences were identified for the postoperative complications, complication-related reoperations or recurrences. Less favorable intraoperative complication results in the female sex were observed only for the onlay technique. Conclusions Female sex is an independent risk factor for chronic pain after elective incisional hernia repair.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - H Hoffmann
- Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - D Weyhe
- Pius Hospital Oldenburg, Medical Campus of University of Oldenburg, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany
| | - W Reinpold
- Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Groß Sand 3, 21107, Hamburg, Germany
| | - A Koch
- Hernia Center Cottbus, Gerhard-Hauptmann-Strasse 15, 03044, Cottbus, Germany
| | - P Kirchhoff
- Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
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Oma E, Jensen KK, Jorgensen LN, Bisgaard T. Incisional hernia repair in women of childbearing age: A nationwide propensity-score matched study. Scand J Surg 2019; 109:295-300. [PMID: 31510874 DOI: 10.1177/1457496919874482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND & AIMS Although incisional hernia repair in women of childbearing age is not rare, hernia disease in this group of patients is sparsely documented. The aim of this study was to examine long-term clinical results after incisional hernia repair in women of childbearing age. MATERIAL AND METHODS This nationwide cohort study examined incisional hernia repair from 2007 to 2013 in women of childbearing age, registered prospectively in the Danish Ventral Hernia Database. All women with a subsequent pregnancy were included, and a 1:3 propensity-score matched group of women with an incisional hernia repair without a subsequent pregnancy. A prospective follow-up was conducted, including a validated questionnaire. The primary outcome was recurrence, and the secondary outcome was chronic pain from the operated site. RESULTS In total, 124 (70.5%) women responded, 47 and 77 women with and without a subsequent pregnancy, respectively. The 5-year cumulative incidence of recurrence was 41.0% (95% confidence interval 32.0%-49.9%). After adjustment for potential confounders, subsequent pregnancy was independently associated with recurrence (hazard ratio 1.83, 95% confidence interval 1.02-3.29, p = 0.044). Twenty-six (21.0%) women reported chronic pain (moderate, n = 21; severe, n = 5) with no difference between women with and without a subsequent pregnancy. Hernia recurrence, higher body mass index, and smoking were associated with chronic pain. CONCLUSION Pregnancy following incisional hernia repair was associated with an increased risk of recurrence, but not with chronic pain.
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Affiliation(s)
- E Oma
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - K K Jensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - T Bisgaard
- Gastrounit, Surgical Division, Centre for Surgical Research, Hvidovre Hospital, Hvidovre, Denmark
- University of Copenhagen, Copenhagen, Denmark
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Maloney SR, Schlosser KA, Prasad T, Colavita PD, Kercher KW, Augenstein VA, Heniford BT. The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias. Surg Endosc 2019; 34:981-987. [DOI: 10.1007/s00464-019-06892-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
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Lötsch J, Ultsch A, Kalso E. Prediction of persistent post-surgery pain by preoperative cold pain sensitivity: biomarker development with machine-learning-derived analysis. Br J Anaesth 2019; 119:821-829. [PMID: 29121286 DOI: 10.1093/bja/aex236] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 12/19/2022] Open
Abstract
Background To prevent persistent post-surgery pain, early identification of patients at high risk is a clinical need. Supervised machine-learning techniques were used to test how accurately the patients' performance in a preoperatively performed tonic cold pain test could predict persistent post-surgery pain. Methods We analysed 763 patients from a cohort of 900 women who were treated for breast cancer, of whom 61 patients had developed signs of persistent pain during three yr of follow-up. Preoperatively, all patients underwent a cold pain test (immersion of the hand into a water bath at 2-4 °C). The patients rated the pain intensity using a numerical ratings scale (NRS) from 0 to 10. Supervised machine-learning techniques were used to construct a classifier that could predict patients at risk of persistent pain. Results Whether or not a patient rated the pain intensity at NRS=10 within less than 45 s during the cold water immersion test provided a negative predictive value of 94.4% to assign a patient to the "persistent pain" group. If NRS=10 was never reached during the cold test, the predictive value for not developing persistent pain was almost 97%. However, a low negative predictive value of 10% implied a high false positive rate. Conclusions Results provide a robust exclusion of persistent pain in women with an accuracy of 94.4%. Moreover, results provide further support for the hypothesis that the endogenous pain inhibitory system may play an important role in the process of pain becoming persistent.
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Affiliation(s)
- J Lötsch
- Institute of Clinical Pharmacology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - A Ultsch
- DataBionics Research Group, University of Marburg, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
| | - E Kalso
- Department of Perioperative Medicine, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Bartels K, Fernandez-Bustamante A, McWilliams SK, Hopfer CJ, Mikulich-Gilbertson SK. Long-term opioid use after inpatient surgery - A retrospective cohort study. Drug Alcohol Depend 2018; 187:61-65. [PMID: 29627407 PMCID: PMC5991834 DOI: 10.1016/j.drugalcdep.2018.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Knowledge of incidence and risk factors for long-term opioid prescribing is critical for surgical patients. In this retrospective cohort study, we linked information available at the time of surgery with prescription data to ascertain characteristics associated with prolonged opioid therapy. METHODS Patients (n = 6003) with claims in the Colorado All Payer Claims Database (APCD) were matched with 20,501 encounters in a clinical database. Rates of prescription filling were defined by at least one monthly opioid claim relative to the date of surgery. Associations of variables with claims during months 2-6 post-operatively ("long-term prescription filling") were evaluated, and significant variables were jointly modeled using binomial regression. RESULTS Rates of patients filling opioid prescriptions preoperatively [month (M) relative to date of surgery] were 22%(-3 M), 24%(-2 M), and 27%(-1 M); after surgery, opioid fill rates were 62%(1 M), 28%(2 M), 24%(3), 24%(4 M), 23%(5 M), and 22%(6 M). The majority, 71-76%, of patients filling prescriptions in months 2-6 after surgery had also filled before surgery. In the binomial regression model, long-term opioid use was associated with prior opioid use (p < 0.0001), age ≥26 to <65 relative to age ≥ 65 (p < 0.0001), orthopedic surgery (p = 0.001), colorectal surgery (p = 0.003), multiple procedures (p < 0.0001), and worse physical status classification (p < 0.0001). CONCLUSIONS Patients who had filled opioid prescriptions preoperatively comprised the majority of the group who filled long-term prescriptions. Surgical procedures were associated with discontinuation of previous opioid prescribing in some patients. For others, surgery marked the initiation of prolonged opioid therapy. Surgical encounters should include interventions aimed to reduce long-term opioid use.
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Affiliation(s)
- Karsten Bartels
- Department of Anesthesiology, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA.
| | - Ana Fernandez-Bustamante
- Department of Anesthesiology, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Shannon K McWilliams
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Christian J Hopfer
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Susan K Mikulich-Gilbertson
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Biostatistics and Informatics, University of Colorado, School of Public Health, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
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Bittner Iv JG, Cesnik LW, Kirwan T, Wolf L, Guo D. Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches. J Robot Surg 2018; 12:625-632. [PMID: 29453731 PMCID: PMC6223756 DOI: 10.1007/s11701-018-0790-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
Abstract
Few publications describe the potential benefit of robotic-assisted inguinal hernia repair on acute postoperative groin pain (APGP). This study compared patients’ perceptions of APGP, activity limitation, and overall satisfaction after robotic-assisted- (R), laparoscopic (L), or open (O) inguinal hernia repair (IHR). Random samples of patients from two web-based research panels and surgical practices were screened for patients who underwent IHR between October 28, 2015 and November 1, 2016. Qualified patients were surveyed to assess perceived APGP at 1 week postoperatively, activity disruption, and overall satisfaction. Three cohorts based on operative approach were compared after propensity matching. Propensity scoring resulted in 83 R-IHR matched to 83 L-IHR respondents, while 85 R-IHR matched with 85 O-IHR respondents. R-IHR respondents recalled less APGP compared to respondents who had O-IHR (4.1 ± 0.3 vs 5.6 ± 0.3, p < 0.01) but similar APGP compared to L-IHR (4.0 ± 0.3 vs 4.4 ± 0.3, p = 0.37). Respondents recalled less activity disruption 1 week postoperatively after R-IHR versus O-IHR (6.1 ± 0.3 vs. 7.3 ± 0.2, p < 0.01) but similar levels of activity disruption after R-IHR and L-IHR (6.0 ± 0.3 vs. 6.6 ± 0.27, p = 0.32). At the time of the survey, respondents perceived less physical activity disruption after R-IHR compared to O-IHR (1.4 ± 0.2 vs. 2.8 ± 0.4, p < 0.01) but similar between R-IHR and L-IHR (1.3 ± 0.2 vs 1.2 ± 0.2, p = 0.94). Most respondents felt satisfied with their outcome regardless of operative approach. Patient perceptions of pain and activity disruption differ by approach, suggesting a potential advantage of a minimally invasive technique over open for IHR. Further studies are warranted to determine long-term outcomes regarding pain and quality of life after IHR.
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Affiliation(s)
- James G Bittner Iv
- Department of Surgery, Virginia Commonwealth University School of Medicine, PO Box 980519, Richmond, VA, 23298, USA.
| | - Lawrence W Cesnik
- Market Research Department, Intuitive Surgical, Inc., Sunnyvale, CA, USA
| | - Thomas Kirwan
- Bruno and Ridgway Research Associates, Lawrenceville, NJ, USA
| | - Laurie Wolf
- Bruno and Ridgway Research Associates, Lawrenceville, NJ, USA
| | - Dongjing Guo
- Department of Clinical Affairs, Intuitive Surgical, Inc., Sunnyvale, CA, USA
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Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias. Am J Surg 2018; 215:610-617. [PMID: 29402389 DOI: 10.1016/j.amjsurg.2018.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care. METHODS Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR. RESULTS In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41.8%). Among 41 patients who initiated additional unsolicited complaints of pain, an actionable diagnosis was found in only 3 patients. Risk factors for such complaints included pre-operative pain and the use of synthetic mesh. CONCLUSIONS Even in the absence of an actionable diagnosis, significant resources are utilized in evaluation and management of unsolicited complaints of pain in the first year after cVHR.
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Sun P, Fei Y, Wang S, Zhang Y, Li J. [Efficacy comparison between ProGrip self-gripping mesh and polypropylene mesh for retromuscular repair of incisional hernias]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:331-334. [PMID: 29806264 PMCID: PMC8458109 DOI: 10.7507/1002-1892.201611040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/12/2017] [Indexed: 11/03/2022]
Abstract
Objective To compare the efficacy of retromuscular repair of incisional hernia by using ProGrip self-gripping mesh and conventional polypropylene mesh. Methods A retrospective analysis was made on clinical data of 83 cases of incisional hernia between May 2012 and May 2016. Of 83 cases, ProGrip self-gripping mesh was used in 46 cases (self-gripping mesh group) and conventional polypropylene mesh (conventional mesh group) in 37 cases. There was no significant difference in gender, age, body mass index, types of incision hernia, hernia ring diameter, course of disease, and associated disease between 2 groups ( P>0.05). The operative time, hospital stays, and visual analogue scale (VAS) were recorded and compared between 2 groups. Results The self-gripping mesh group was significantly lower than conventional mesh group in operative time and hospital stays ( t=2.977, P=0.004; t=2.270, P=0.026). Primary healing of incision was obtained in 2 groups, with no seroma and mesh infection. The VAS score of self-gripping mesh group was significantly lower than that of conventional mesh group at 24 hours, 7 days, and 30 days after operation ( P<0.05). The follow-up time was 5-53 months (mean, 25.8 months) in 43 patients of self-gripping mesh group, and was 7-54 months (mean, 27.4 months) in 33 patients of conventional mesh group. No chronic pain or hernia recurrence was found in both groups during follow-up time. Conclusion It is a safe and feasible curative way to use ProGrip self-gripping mesh for retromuscular repair of incisional hernia as it can reduce operative time, hospital stays, and postoperative pain.
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Affiliation(s)
- Pengjun Sun
- Department of General Surgery, the First Hospital Affiliated to General Hospital of Chinese PLA, Beijing, 100048, P.R.China
| | - Yang Fei
- Department of General Surgery, the First Hospital Affiliated to General Hospital of Chinese PLA, Beijing, 100048, P.R.China
| | - Shibin Wang
- Department of General Surgery, the First Hospital Affiliated to General Hospital of Chinese PLA, Beijing, 100048, P.R.China
| | - Yan Zhang
- Department of General Surgery, the First Hospital Affiliated to General Hospital of Chinese PLA, Beijing, 100048, P.R.China
| | - Jiye Li
- Department of General Surgery, the First Hospital Affiliated to General Hospital of Chinese PLA, Beijing, 100048,
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