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Risk Factors for Long-term Pain After Hernia Surgery

Fränneby, Ulf MD*; Sandblom, Gabriel MD, PhD; Nordin, Pär MD, PhD; Nyrén, Olof§; Gunnarsson, Ulf

doi: 10.1097/01.sla.0000218081.53940.01
Original Articles

Objective: To estimate the prevalence of residual pain 2 to 3 years after hernia surgery, to identify factors associated with its occurrence, and to assess the consequences for the patient.

Summary Background Data: Iatrogenic chronic pain is a neglected problem that may totally annul the benefits from hernia repair.

Methods: From the population-based Swedish Hernia Register 3000 patients aged 15 to 85 years were sampled from the 9280 patients registered as having undergone a primary groin hernia operation in the year 2000. Of these, the 2853 patients still alive in 2003 were requested to fill in a postal questionnaire.

Results: After 2 reminders, 2456 patients (86%), 2299 men and 157 women responded. In response to a question about “worst perceived pain last week,” 758 patients (31%) reported pain to some extent. In 144 cases (6%), the pain interfered with daily activities. Age below median, a high level of pain before the operation, and occurrence of any postoperative complication were found to significantly and independently predict long-term pain in multivariate logistic analysis when “worst pain last week” was used as outcome variable. The same variables, along with a repair technique using anterior approach, were found to predict long-term pain with “pain right now” as outcome variable.

Conclusion: Pain that is at least partly disabling appears to occur more often than recurrences. The prevalence of long-term pain can be reduced by preventing postoperative complications. The impact of repair technique on the risk of long-term pain shown in our study should be further assessed in randomized controlled trials.

Thirty-one percent of 2853 patients, who answered a postal questionnaire 2 to 3 years after inguinal hernia surgery, still had pain in the operated groin. Six percent had pain of such severity that it interfered with daily activities. Young age, preoperative pain level above average, postoperative complications, and anterior approach independently predicted long-term pain.

From the *Department of Surgery, Södersjukhuset, Stockholm; †Department of Surgery, Akademiska Sjukhuset, Uppsala; ‡Department of Surgery, östersunds Sjukhus, östersund; §Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; and ∥Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden.

Supported by the National Board of Health and Welfare (Sweden).

Reprints: Ulf Fränneby, MD, Department of Surgery, Södersjukhuset, SE-118 83 Stockholm, Sweden. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.