Outcomes of transversus abdominis plane block in ventral hernia repair: A propensity score matching analysis using a national database

Abstract

BACKGROUND: Transversus abdominis plane (TAP) block is often used for post-operative analgesia in ventral hernia repair (VHR). Most studies evaluating TAP in VHR are single-center studies. Our objective was to evaluate the outcomes of TAP in VHR using a national database. MATERIALS AND METHODS: We conducted a retrospective cohort study using Vizient Clinical Database. We included outpatient VHR in adults between 2017 and 2019. Patient, hernia, operative, and hospital characteristics were collected. The patients were divided into two groups depending on whether or not they received TAP. One-to-one propensity score matching (PSM) was used to create balanced groups. Rate of overnight stay, in-hospital opioid prescribing, and costs were compared between both groups. RESULTS: A total of 108,765 patients met the inclusion criteria. After PSM, there were 1,459 patients in each group. There were no statistically significant differences in baseline characteristics between the matched groups. There was no difference in the rates of overnight stay between the two groups (no-TAP=6%, TAP=7%, odds ratio [OR]=1.3, 95% confidence interval [CI] [0.997,1.77]). There were no clinically significant differences in the percentage of patients prescribed opioids (no-TAP=96%, TAP=95%, OR=0.70, 95% CI [0.50, 0.99]) or mean number of opioid doses prescribed (no-TAP=2.7, TAP=2.7, mean pairwise difference [MPD]=0.02, 95% CI [–0.10, 0.13]). The TAP group was associated with higher median direct cost ($4,400 vs. $3,200; MPD=$1,200, 95% CI [$1,000, $1,400]) and total cost ($7,100 vs. $5,200; MPD=$1,900, 95% CI [$1,600, $2,100]) when compared with the no-TAP group. CONCLUSION: We found no evidence that TAP in outpatient VHR was associated with the reduction in the rate of overnight stay or in-hospital opioid prescribing. However, TAP was associated with higher procedural costs.