Implementation of a Patient-Tailored Opioid Prescribing Guideline in Ventral Hernia Surgery

Lindros, Sydney H.; Warren, Jeremy A.; Carbonell, Alfredo M.; Cobb, William S.; Floyd, Sarah B.

doi:10.1016/j.jss.2022.09.021

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…For example, Ciampa et al [14] discussed the importance of patient pain management education and shared decision-making with hernia patients in reducing the average opioid prescription size from 12.29 to 6.80 pills. Similarly, VHR patients receiving guideline-based opioid prescriptions were sent home with lower opioid dosages [15]. This study adds significant data about the feasibility of using non-opioid analgesics as a successful alternative to opioids in controlling postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair

Alzatari,

Huang,

Poulose

2024

Hernia

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Purpose Managing postoperative pain remains a significant challenge in hernia operations. With ventral hernia repair (VHR) being one of the most commonly performed procedures, this study aimed to compare the effectiveness of non-opioid analgesia to opioid-based regimens for postoperative pain management. Methods The Abdominal Core Health Quality Collaborative was queried for elective VHR patients between 2019–2022. Subjects prescribed opioid or non-opioid analgesics at discharge were matched using a propensity score. Postoperative Hernia-Related Quality of Life Survey (HerQLes) summary scores, Patient-Reported Outcome Measurement Information System (PROMIS) 3a questionnaire, and clinical outcomes were compared between the two groups. Results 1,051 patients who underwent VHR met the study criteria. The 2:1 matched demographics were opioids (n = 188) and non-opioids (n = 94) (median age 63, 48% females, 91% white, and 6.5 cm hernia length). Long-term (1-year post-operation) patients’ pain levels were similar between opioids vs non-opioids (median (IQR): 31(31–40) vs. 31(31–40), p = 0.46), and HerQLes summary scores were similar (92(78–100) vs. 90(59–95), p = 0.052). Clinical short-term (30-days post-operation) outcomes between opioid vs non-opioid patients had similar length-of-stay (1(0–5) vs 2(0–6), P = 0.089), readmissions (3% vs. 1%, P = 0.28), recurrences (0% vs. 0%, P = 1), reoperations (1% vs. 0%, P = 0.55), surgical site infections (3% vs. 7%, P = 0.11), surgical site occurrences (5% vs. 6%, P = 0.57), and surgical site occurrences requiring procedural intervention (3% vs. 6%, P = 0.13). Finally, long-term recurrence rates were similar (12% vs. 12%, P = 1). Conclusion Non-opioid postoperative regimens for analgesia are non-inferior to opioids in VHR patients with similar outcomes. Aggressive efforts should be undertaken to reduce opioid use in this population.

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Section: Discussionmentioning

confidence: 99%