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Prognostic value of age for chronic postoperative inguinal pain
H R Langeveld1, P Klitsie, H Smedinga
1Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands, hesterlangeveld@hotmail.com.
Insights
Younger patients undergoing inguinal hernia repair face a higher risk of chronic postoperative inguinal pain (CPIP). Age is a significant prognostic factor for CPIP, independent of hernia type or surgical technique.
Area of Science:
- Surgical outcomes research
- Pain management
- Hernia surgery
Background:
- Chronic postoperative inguinal pain (CPIP) is a significant complication following inguinal hernia repair.
- Younger age is a potential risk factor for chronic pain after surgery.
Purpose of the Study:
- To evaluate the prognostic value of patient age on the incidence and intensity of CPIP.
- To investigate age as a risk factor for CPIP after inguinal hernia repair.
Main Methods:
- Analysis of data from the LEVEL trial, a randomized trial comparing TEP and Lichtenstein techniques.
- Inclusion of 669 patients with data on preoperative pain, postoperative pain, and CPIP at one year.
- Regression analysis to assess the association of age with pain incidence and intensity, considering hernia type and surgical technique.
Main Results:
- Younger patients (18-40 years) had a higher incidence of CPIP (43%) compared to middle-aged (29%) and elderly (19%) groups.
- Younger and middle-aged patients reported more preoperative pain and higher pain intensity in the early postoperative period.
- Indirect hernias were more common in younger patients but did not correlate with CPIP or surgical technique.
Conclusions:
- Approximately 27% of patients develop CPIP after inguinal hernia repair.
- Younger age is a significant predictor of increased risk for developing CPIP.
- Hernia type and surgical technique did not demonstrate a significant influence on CPIP development.
Purpose:
Chronic postoperative inguinal pain (CPIP) is considered the most common and serious long-term problem after inguinal hernia repair. Young age has been described as a risk factor for developing chronic pain after several surgical procedures. Our aim was to assess if age has prognostic value on CPIP.
Methods:
The database of a randomized trial; the LEVEL trial, 669 patients, TEP versus Lichtenstein, was used for analysis. Data on incidence and intensity of preoperative pain, postoperative pain and CPIP at 1 year were collected. The association of age with incidence and intensity of pain was assessed with regression analysis. Further, hernia type and surgical technique were studied in combination with age and CPIP as possible risk factors on CPIP over age alone.
Results:
Younger patients (18-40 years) presented more often with CPIP than middle-aged patients (40-60 years) and elderly (>60 years); 43 vs. 29 vs. 19 %; overall 27 %. Younger and middle-aged patients had more frequently preoperative pain; 54 vs. 55 vs. 41 % and intensity of pain was higher during the first three postoperative days (VAS on day 1: 5.5 vs. 4.5 vs. 3.9 and on day 3: 3.8 vs. 2.9 vs. 2.6). Indirect-type hernias were seen more often in younger patients (77 vs. 51 vs. 48 %) and were not related to CPIP or with surgical technique.
Conclusions:
Almost one out of three patients experiences CPIP. The younger the patient, the higher the risk of CPIP. Hernia type and surgical technique did not influence CPIP.
