Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment.

IF 2.6 2区医学 Q1 SURGERY Hernia Pub Date : 2024-10-01 Epub Date: 2024-03-25 DOI:10.1007/s10029-024-03027-7

A Widder, L Reese, J F Lock, A Wiegering, C-T Germer, H L Rittner, U A Dietz, N Schlegel, M Meir

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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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慢性手术后疼痛（CPSP）：切口疝治疗后一个被低估的问题。

背景：慢性手术后疼痛（CPSP）是开放性切口疝修补术后的一个潜在的长期问题，尽管疝的解剖学修补成功，但它可能会影响患者的生活质量。本文旨在确定开放切口疝修补术后患者发生 CPSP 的风险因素及其结果：方法：对 2015 年至 2021 年期间接受开放式切口疝修补术的患者进行了单中心回顾性分析。利用当地数据库对患者术前存在的疾病（如糖尿病和恶性肿瘤）、疝气复杂程度、术后并发症和术后止痛药物进行了分析。使用 EuraHS 生活质量（QoL）问卷对生活质量和 CPSP 进行评估：根据完整的EuraHS（QoL）问卷，共对182个病例进行了回顾性详细分析。在平均 46 个月的随访期间，长期随访结果显示，开腹切口疝手术后 CPSP 的发生率为 54.4%，其中严重 CPSP（sCPSP）的发生率为 14.8%。疝气的复杂程度和人口统计学变量在有 CPSP 和没有 CPSP 的人群中没有差异。CPSP患者的生活质量明显下降。CPSP患者的镇痛评分（包括术后最初几天的镇痛药物需求）明显高于无CPSP患者（无CPSP：2.86 vs. CPSP：3.35；P = 0.047）：结论：开腹切口疝修补术后出现的 CPSP 是一个经常出现且被低估的长期问题，以前从未被认识到如此严重的程度。CPSP 会损害这些患者的生活质量。在围手术期，可以通过使用镇痛剂评分来识别需要大剂量镇痛药物的高危患者。及时调整止痛药物，即使是在家庭环境中，也可能减轻 CPSP 的慢性化或严重程度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.