Tsirline Victor B, Colavita Paul D, Belyansky Igor, Zemlyak Alla Y, Lincourt Amy E, Heniford B Todd
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Am Surg. 2013 Aug;79(8):829-36. doi: 10.1177/000313481307900828.
With evolution of hernia repair surgery, quality of life (QOL) became a major outcome measure in nearly 350,000 ventral hernia repairs (VHRs) performed annually in the United States. This study identified predictors of chronic pain after VHR. A prospective database of patient-reported QOL outcomes at a tertiary referral center was queried from 2007 to 2010; 512 patients met inclusion criteria. Factors including demographics, medical comorbidities, preoperative symptoms, and hernia characteristics were analyzed using advanced statistical modeling. Average age was 56.4 years, 57.6 per cent were males, mean body mass index was 33 kg/m(2), hernia defect size was 138 cm(2), and 35.5 per cent were repaired laparoscopically. Preoperatively, 69 per cent of patients had mild and 28 per cent severe pain during some activities. Pain levels were elevated in the first month postoperatively; by 6 months, patients reported significant improvement. The most significant and consistent predictor of postoperative pain was the presence of preoperative pain (odds ratio, 2.1; 95% confidence interval, 1.4 to 3.0; P = 0.0001). Older patients and men had less postoperative pain, but they also had less preoperative pain, so these factors were not independent predictors. Patients with minimal preoperative symptoms uniformly experienced resolution of pain by 6 months postoperatively. Among patients with severe preoperative pain, one-third reported long-term resolution of pain, and one-third had persistent severe pain. The former group had smaller hernias (91 vs 194 cm(2), respectively, P = 0.015). Cases of new-onset, long-term pain after VHR were rare (less than 2%). Most patients' symptoms resolve by 6 months after surgery, but those with severe preoperative pain are at risk for persistent postoperative pain.
随着疝修补手术的发展，生活质量（QOL）成为美国每年进行的近350,000例腹疝修补术（VHR）的一项主要疗效指标。本研究确定了VHR术后慢性疼痛的预测因素。查询了2007年至2010年在一家三级转诊中心的患者报告的QOL结果的前瞻性数据库；512例患者符合纳入标准。使用先进的统计模型分析了包括人口统计学、内科合并症、术前症状和疝特征等因素。平均年龄为56.4岁，57.6%为男性，平均体重指数为33kg/m²，疝缺损大小为138cm²，35.5%通过腹腔镜进行修补。术前，69%的患者在某些活动期间有轻度疼痛，28%有重度疼痛。术后第一个月疼痛水平升高；到6个月时，患者报告有显著改善。术后疼痛最显著且一致的预测因素是术前存在疼痛（优势比，2.1；95%置信区间，1.4至3.0；P = 0.0001）。老年患者和男性术后疼痛较轻，但他们术前疼痛也较轻，因此这些因素不是独立的预测因素。术前症状轻微的患者在术后6个月时疼痛均得到缓解。在术前有重度疼痛的患者中，三分之一报告疼痛长期缓解，三分之一有持续的重度疼痛。前一组的疝较小（分别为91cm²和194cm²，P = 0.015）。VHR术后新发长期疼痛的病例很少（不到2%）。大多数患者的症状在术后6个月时缓解，但术前有重度疼痛的患者有术后持续疼痛的风险。
