Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, San Diego, CA, USA.
Center for the Future of Surgery, University of California of San Diego, MET Building, Lower Level, 9500 Gilman Drive MC 0740, La Jolla, CA, 92093-0740, USA.
Surg Endosc. 2022 Sep;36(9):6742-6750. doi: 10.1007/s00464-021-08950-9. Epub 2022 Jan 4.
Potential complications after inguinal hernia repair include uncontrolled post-operative pain and post-operative urinary retention (POUR). Enhanced Recovery After Surgery (ERAS) protocols aim to mitigate post-operative morbidity. We study the impact of ERAS measures alongside discharge without a narcotic prescription on post-operative pain and POUR after minimally invasive inguinal hernia repair.
A retrospective review of a prospectively maintained database identified patients that underwent minimally invasive inguinal hernia repair at a single institution. Intra-operative data included operative time, narcotic usage, non-narcotic adjunct medication, and fluid administration. Primary outcomes included rates of POUR and uncontrolled post-operative pain. Operations performed after 2018 were included in the ERAS cohort. Uncontrolled post-operative pain was defined as needing additional narcotic prescriptions, admission, or ER visits for post-operative pain. POUR was defined as requiring an indwelling urethral catheter at discharge, admission for retention, or returning to the ER for urinary retention.
Between January 2008 and March 2021, 1097 patients who underwent minimally invasive inguinal hernia repair were identified. 91.3% of these procedures were laparoscopic and 8.7% were robotic. Average patient age was 57.4 years, 93% were male. Patients receiving care after initiation of the ERAS protocol were significantly less likely to experience POUR when compared to their prior counterparts (1.4% vs. 4.2% p = 0.01); there was no difference in post-operative pain complications (1.4% vs. 2.9% p = 0.15). Patients who were discharged without a narcotic prescription had 0% incidence of POUR. Significant differences were found between the ERAS and non-ERAS cohort regarding narcotic usage and fluid administration. Age, higher fluid volume, and higher narcotic usage were found to be risk factors for POUR while ERAS, sugammadex, and dexamethasone were found to be protective.
Implementation of an ambulatory ERAS protocol can significantly decrease urinary retention and narcotic usage rates after minimally invasive inguinal hernia repair.
腹股沟疝修补术后的潜在并发症包括术后疼痛控制不佳和术后尿潴留（POUR）。强化术后康复（ERAS）方案旨在降低术后发病率。我们研究了 ERAS 方案措施联合无阿片类药物处方出院对微创腹股沟疝修补术后疼痛和 POUR 的影响。
对一家机构前瞻性维护的数据库进行回顾性分析，确定接受微创腹股沟疝修补术的患者。术中数据包括手术时间、阿片类药物使用、非阿片类辅助药物和液体管理。主要结局包括 POUR 和术后疼痛控制不佳的发生率。2018 年后进行的手术被纳入 ERAS 组。术后疼痛控制不佳定义为需要额外的阿片类药物处方、入院或急诊就诊以缓解术后疼痛。POUR 定义为出院时需要留置导尿管、因尿潴留入院或因尿潴留返回急诊。
2008 年 1 月至 2021 年 3 月，共确定 1097 例接受微创腹股沟疝修补术的患者。这些手术中 91.3%为腹腔镜手术，8.7%为机器人手术。患者平均年龄为 57.4 岁，93%为男性。与之前的患者相比，接受 ERAS 方案治疗的患者发生 POUR 的可能性明显降低（1.4%比 4.2%，p=0.01）；术后疼痛并发症无差异（1.4%比 2.9%，p=0.15）。未开具阿片类药物处方出院的患者 POUR 发生率为 0%。ERAS 组和非 ERAS 组在阿片类药物使用和液体管理方面存在显著差异。年龄、较高的液体量和较高的阿片类药物使用与 POUR 发生相关，而 ERAS、舒更葡糖和地塞米松与 POUR 发生呈负相关。
实施门诊 ERAS 方案可显著降低微创腹股沟疝修补术后尿潴留和阿片类药物使用率。
