TY - JOUR

T1 - Inguinal hernia repair among men

T2 - development and validation of a preoperative risk score for persistent postoperative pain

AU - Vad, M. V.

AU - Svendsen, S. W.

AU - Frost, P.

AU - Nattino, G.

AU - Rosenberg, J.

AU - Lemeshow, S.

N1 - Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag France SAS part of Springer Nature.

PY - 2022

Y1 - 2022

N2 - Purpose: Persistent postoperative pain (PPP) is a prevalent complication after inguinal hernia repair. The aim of this study was to develop and validate a preoperative risk score for PPP. Methods: We developed the risk score based on a cohort of 2,508 Danish men, who answered a questionnaire six months after inguinal hernia repair performed 2015–2016. PPP was defined as a numerical rating scale score ≥ 2 during activity six months postoperatively. Logistic regression analyses were undertaken to determine statistically significant predictors of PPP. Univariable analysis selected potential predictors with a p value ≤ 0.20, and a subsequent multivariable model was built using backward elimination with a criterion of p value < 0.10. We created a risk score based on the β coefficients of the multivariable model. The risk score was validated internally using Hosmer–Lemeshow goodness of fit test, calibration belt test, and receiver operating characteristic curve analyses with 95% confidence intervals based on the bootstrap analysis. External validation was performed in a cohort of 293 men recruited preoperatively. Results: Predictors of PPP were age 18–49 and 50–59 (versus ≥ 60) years (p < 0.001), total load lifted > 1,000 kg/day (p = 0.001), working in a bent-over position > 1 h/day (p < 0.001), leisure-time physical activity < 2 h/week (p = 0.009), increasing body mass index (per unit) (p < 0.003), and repair of recurrent hernia (p = 0.001).The preoperative risk score predicted risks of 6–61% in the development population. The model showed good internal and external validity. Conclusion: The results suggest that the risk of PPP after inguinal hernia repair can be predicted using a preoperative risk score.

AB - Purpose: Persistent postoperative pain (PPP) is a prevalent complication after inguinal hernia repair. The aim of this study was to develop and validate a preoperative risk score for PPP. Methods: We developed the risk score based on a cohort of 2,508 Danish men, who answered a questionnaire six months after inguinal hernia repair performed 2015–2016. PPP was defined as a numerical rating scale score ≥ 2 during activity six months postoperatively. Logistic regression analyses were undertaken to determine statistically significant predictors of PPP. Univariable analysis selected potential predictors with a p value ≤ 0.20, and a subsequent multivariable model was built using backward elimination with a criterion of p value < 0.10. We created a risk score based on the β coefficients of the multivariable model. The risk score was validated internally using Hosmer–Lemeshow goodness of fit test, calibration belt test, and receiver operating characteristic curve analyses with 95% confidence intervals based on the bootstrap analysis. External validation was performed in a cohort of 293 men recruited preoperatively. Results: Predictors of PPP were age 18–49 and 50–59 (versus ≥ 60) years (p < 0.001), total load lifted > 1,000 kg/day (p = 0.001), working in a bent-over position > 1 h/day (p < 0.001), leisure-time physical activity < 2 h/week (p = 0.009), increasing body mass index (per unit) (p < 0.003), and repair of recurrent hernia (p = 0.001).The preoperative risk score predicted risks of 6–61% in the development population. The model showed good internal and external validity. Conclusion: The results suggest that the risk of PPP after inguinal hernia repair can be predicted using a preoperative risk score.

KW - Chronic postsurgical pain

KW - Hernia repair

KW - Herniorrhaphy

KW - Inguinal hernia

KW - Inguinal pain

KW - Lifting

KW - Occupational exposure

KW - Prediction

KW - Prognosis

U2 - 10.1007/s10029-021-02376-x

DO - 10.1007/s10029-021-02376-x

M3 - Journal article

C2 - 33570707

AN - SCOPUS:85100787226

VL - 26

SP - 177

EP - 187

JO - Hernia : the journal of hernias and abdominal wall surgery

JF - Hernia : the journal of hernias and abdominal wall surgery

SN - 1265-4906

ER -