Predictors of Inguinodynia Following Open Inguinal Herniorrhaphy
Patel, Prachi M.
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BACKGROUND: Inguinodynia (pain ≥ 3 months following surgery) following open repair of inguinal hernias continues to be an important complication. We hypothesize that there are factors that can predict inguinodynia. This data could be used to identify techniques that aim at its prevention. METHODS: This a retrospective, single institution, single surgeon experience at the VA North Texas Health Care system between July 2005 to July 2015. All patients underwent the same standardized mesh repair. Using inguinodynia as the dependent variable, univariate analysis (UA) was performed using Fisher's Exact Test for categorical and Student's T-Test for continuous variables. Clinically relevant variables and variables with a p≤0.2 were entered included in a logistic regression model with inguinodynia as the dependent variable. Data are expressed as means ± SD and significance was established at a p ≤ 0.05 (two-sided). RESULTS: During the study period, 935 patients underwent open inguinal hernia repair (99 ± 0.3 % male, 60.4 ± 1.4 years-old, BMI 26.7 ± 4.2 Kg/m2, 72.9% Caucasian, American Society of Anesthesiologists average 2.5, morbidity rate of 11.9 by the same surgeon. Fourteen patients experienced inguinodynia (1.5 %). Patients who experienced inguinodynia were more likely to have a prior contralateral inguinal hernia repair (29% vs 7%, p=0.02) and more likely to have a laparascopic repair (14% vs 1%, p=0.01). Patients with inguinodynia were more likely to be younger (54 years vs 61 years, p=0.01), current smokers (64% vs 32%, p =0.02), and have a post-operative complication (36% vs 7%, p <0.01). Multivariate analysis identified a prior repair of a contralateral hernia (OR and 95% CI: 5.4; 1.2-22.0), laparascopic repair (15.2; 1.7-133.3), a current history of smoking (4.4; 1.2-16.7), younger age (0.96; 0.91-1.0) and post-operative complications (5.1; 1.4-18.5) as independent predictors of inguinodynia. CONCLUSION: Younger patients and patients who have a laprascopic repair, history of a contralateral repair, or who experience a postoperative complication are at risk of inguinodynia. In this cohort, an important independent predictor of inguinodynia was not history of smoking, but rather current smoking. Patients who smoke should be encouraged to quit prior to repair.