P. M. Patel1, A. Mokdad1, T. Pham1,2, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2VA North Texas Health Care System,Surgery,Dallas, TX, USA
Introduction: 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, 804 patients underwent open inguinal hernia repair (99 ± 0.3 % male, 60.4 ± 12.4 years-old, BMI 26.7 ± 4.2 Kg/m2, 72.9% Caucasian, American Society of Anesthesiologists average 2.5, morbidity rate of 7.8 ± 0.9%) by the same surgeon. Fifteen patients experienced inguinodynia (1.9 %). Median follow up was 4.7 ± 2.7 years. Patients who experienced inguinodynia were more likely to have a bilateral hernia repair (26.7 ± 11.4% vs 8.1 ± 1.0%, p=0.01), repair of a recurrent hernia (26.7 ± 11.4% vs 7.0 ± 0.9%, p <0.001), and a simultaneous femoral hernia repair (13.3 ± 8.8% vs 1.0 ± 0.4%, p <0.001). Patients with inguinodynia were more likely to be younger (52.7 ± 10.1 years vs 60.5 ± 12.4 years, p=0.02), current smokers (73.3 ± 11.4% vs 32.6 ± 1.7%, p <0.001), have a positive cardiac health history (16.5 ± 1.3% vs 40.0 ± 12.6%, p=0.02), on anticoagulants (20.0 ± 10.3% vs 3.5 ± 0.7%, p <0.001), and have a post-operative complication (40.0 ± 12.6 % vs 7.2 ± 0.9%, p <0.001). Multivariate analysis identified a concurrent repair of a femoral hernia (OR and 95% CI: 12.2; 1.8-82.0) or recurrent hernia (4.6; 1.2-17.7), a current history of smoking (3.9; 1.1-14.1), younger age (6.4; 1.4-33.7) and post-operative complications (6.5; 2.0-21.4) as independent predictors of inguinodynia.
Conclusion: Younger patients and patients who have a bilateral, recurrent, or a concurrent repair of a femoral hernia as well as those who experience a morbidity are at risk of inguinodynia. Patients who smoke should be encouraged to quit prior to repair.