Risk Factors for Chronic Pain Following Laparoscopic Groin Hernia Repair in the Swedish Hernia Registry: 1. Preoperative Predictors

Abstract Aim This prospective cohort study aimed to identify and quantify preoperative risk factors for chronic postoperative inguinal pain (CPIP) after laparoscopic groin hernia repair. Material and Methods Virtually all patients ≥15 years, operated with TEP or TAPP in Sweden during September 2012–December 2018, were routinely sent a CPIP questionnaire at 1 year postoperatively. This study defined CPIP as “non-ignorable pain in the operated groin anytime during the recent week”. The survey results were analyzed with regard to conceivable preoperative risk factors for CPIP, being previously recorded in the Swedish Hernia Registry. Multivariable logistic regression rendered adjusted odds ratios (OR), with 95% confidence intervals (CI). Results From 80 surgical centers, 29,109 laparoscopic repairs (78% male) were included, with patient mean age 58 years. From 20,455 (70%) questionnaire responders, 5,786 (28%) qualified as having CPIP according to this wide definition. Younger patients were less inclined to respond. Preoperative predictors significantly associated with higher CPIP risk were: Younger and elderly patients. Increasing ASA. Increasing BMI. Female (OR 1.3, CI 1.2–1.4). Smoking (OR 1.4, CI 1.1–1.7). Recurrent hernia (OR 1.3, CI 1.2–1.4). Emergency repair (OR 1.3, CI 1.03–1.7). Each groin in a bilateral repair (OR 1.1, CI 1.05–1.2). Femoral (OR 1.3, CI 1.1–1.6), combined latero-medial (OR 1.2, CI 1.04–1.3) vs. medial hernia. Small vs. large defect (OR 1.2, CI 1.1–1.3). Conclusions The findings should be useful in planning and interpreting other studies, and for clinical counseling and decision making. An age-dependent response rate asymmetry, which is a previously overlooked systematic selection bias issue with CPIP surveys, complicates interpretation.