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Pain outcomes in emergent versus elective ventral hernia repair: Propensity score matched analysis
Sidhant Kalsotra1,2,3, Li-Ching Huang4, Savannah Renshaw1,2,3
1Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner, Columbus, OH, USA.
Introduction:
Whether emergent ventral hernia repair (VHR) compromises long-term patient-reported pain recovery compared to elective repair remains unknown. We compared Patient-Reported Outcomes Measurement Information System Pain Intensity (PROMIS Pain 3a) outcomes between emergent and elective VHR using a multicenter registry after risk adjustment.
Methods:
We performed a retrospective cohort analysis using the Abdominal Core Health Quality Collaborative (ACHQC) registry of adults undergoing VHR from 2013 to 2024 with complete baseline and 30-day PROMIS Pain 3a scores were included. Emergent and elective repairs were compared using 1:3 propensity score matching (PSM) across 31 covariates. The primary outcome was PROMIS Pain 3a T-score at one year postoperatively.
Results:
Of 11,831 patients (94 emergent, 11,737 elective), emergent patients had higher baseline PROMIS Pain 3a T-scores (median 52 [IQR 46-58] vs. 44 [IQR 36-52], p < 0.001), BMI (median 36 [IQR 32-41] vs. 31 [IQR 27-36] kg/m², p < 0.001), and ASA class 3-4 rates (66% vs. 55%, p < 0.001). After PSM (71 emergent, 193 elective), baseline pain scores were equivalent (median 52 [IQR 44-58] vs. 49 [IQR 44-54], p = 0.2). At 30 days, pain scores did not differ (median 44 [IQR 40-52] vs. 46 [IQR 40-52], p = 0.6). At one year, emergent patients reported significantly lower PROMIS Pain 3a T-scores (median 31 [IQR 31-38] vs. 40 [IQR 31-46], p = 0.01) and greater improvement from baseline (median - 21 [IQR - 24 to - 11] vs. -8 [IQR - 16 to 0], p = 0.002). Complication rates and pragmatic recurrence through five years were equivalent between matched groups.
Conclusion:
Emergent VHR patients demonstrated superior patient-reported pain outcomes at one year compared to propensity-matched elective controls, with equivalent complication and recurrence rates. These findings challenge the notion that emergent repairs inherently lead to worse outcomes and suggest that surgical urgency may not negatively impact long-term pain recovery.