Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and Meta-Analysis

Harutyun Alaverdyan; Jooyoung Maeng; Peter K Park; Kavya Narayana Reddy; Michael P Gaume; Lauren Yaeger; Michael M Awad; Simon Haroutounian

doi:10.1016/j.jpain.2024.104532

Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and Meta-Analysis

J Pain. 2024 Apr 8:104532. doi: 10.1016/j.jpain.2024.104532. Online ahead of print.

Authors

Harutyun Alaverdyan¹, Jooyoung Maeng¹, Peter K Park², Kavya Narayana Reddy³, Michael P Gaume⁴, Lauren Yaeger⁵, Michael M Awad⁶, Simon Haroutounian¹

Affiliations

¹ Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri.
² Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri.
³ Department of Anesthesiology and Pain Management, Arkansas Children Hospital, University of Arkansas Medical Science, Little Rock, Arkansas.
⁴ Department of Pain Management, University of Kansas Health System-St Francis Hospital, Topeka, Kansas.
⁵ Bernard Becker Medical Library, Washington University in St Louis School of Medicine, St. Louis, Missouri.
⁶ Department of Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri.

PMID: 38599265
DOI: 10.1016/j.jpain.2024.104532

Abstract

Persistent postsurgical pain (PPSP) is one of the most bothersome and disabling long-term complications after inguinal hernia repair surgery. Understanding perioperative risk factors that contribute to PPSP can help identify high-risk patients and develop risk-mitigation approaches. The objective of this study was to systematically review and meta-analyze risk factors that contribute to PPSP after inguinal hernia repair. The literature search resulted in 303 papers included in this review, 140 of which were used for meta-analyses. Our results suggest that younger age, female sex, preoperative pain, recurrent hernia, postoperative complications, and postoperative pain are associated with a higher risk of PPSP. Laparoscopic techniques reduce the PPSP occurrence compared to anterior techniques such as Lichtenstein repair, and tissue-suture techniques such as Shouldice repair. The use of fibrin glue for mesh fixation was consistently associated with lower PPSP rates compared to tacks, staples, and sutures. Considerable variability was observed with PPSP assessment and reporting methodology in terms of study design, follow-up timing, clarity of pain definition, as well as pain intensity or interference threshold. High or moderate risk of bias in at least one domain was noted in >75% of studies. These may limit the generalizability of our results. Future studies should assess and report comprehensive preoperative and perioperative risk factors for PPSP adjusted for confounding factors, and develop risk-prediction models to drive stratified PPSP-mitigation trials and personalized clinical decision-making. PERSPECTIVE: This systematic review and meta-analysis summarizes the current evidence on risk factors for persistent pain after inguinal hernia repair. The findings can help identify patients at risk and test personalized risk-mitigation approaches to prevent pain. PROSPERO REGISTRATION: htttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=154663.

Keywords: Inguinal hernia repair; meta-analysis; persistent postsurgical pain; risk factors.

Publication types

Review