Risk factors for long-term pain after hernia surgery.
OBJECTIVE
To estimate the prevalence of residual pain 2 to 3 years after hernia surgery, to identify factors associated with its occurrence, and to assess the consequences for the patient.


BACKGROUND
Iatrogenic chronic pain is a neglected problem that may totally annul the benefits from hernia repair.


METHODS
From the population-based Swedish Hernia Register 3000 patients aged 15 to 85 years were sampled from the 9280 patients registered as having undergone a primary groin hernia operation in the year 2000. Of these, the 2853 patients still alive in 2003 were requested to fill in a postal questionnaire.


RESULTS
After 2 reminders, 2456 patients (86%), 2299 men and 157 women responded. In response to a question about "worst perceived pain last week," 758 patients (31%) reported pain to some extent. In 144 cases (6%), the pain interfered with daily activities. Age below median, a high level of pain before the operation, and occurrence of any postoperative complication were found to significantly and independently predict long-term pain in multivariate logistic analysis when "worst pain last week" was used as outcome variable. The same variables, along with a repair technique using anterior approach, were found to predict long-term pain with "pain right now" as outcome variable.


CONCLUSIONS
Pain that is at least partly disabling appears to occur more often than recurrences. The prevalence of long-term pain can be reduced by preventing postoperative complications. The impact of repair technique on the risk of long-term pain shown in our study should be further assessed in randomized controlled trials.
Fränneby
Ulf
U
Department of Surgery, Södersjukhuset, Stockholm, Sweden. ulf.franneby@sodersjukhuset.se
Sandblom
Gabriel
G
Nordin
Pär
P
Nyrén
Olof
O
Gunnarsson
Ulf
U
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000453:epidemiology; D006550:Hernia, Femoral / Q000601:surgery*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010149:Postoperative Pain / Q000453:epidemiology*; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome