FROM THE AMERICAN JOURNAL OF SURGERY

After surgery for complex ventral hernia repair, a significant number of patients make unscheduled calls or visits to the clinic or ED because of pain. And although these calls and visits are costly in health care resources, many patients do not receive an actionable diagnosis, according to a study published in The American Journal of Surgery .

Colin G. DeLong, MD, and his colleagues reviewed health records of patients who underwent an open procedure for complex ventral hernia repair (cVHR) at Penn State Milton S. Hershey Medical Center in Hershey, Penn., between January 2013 and August 2015 using the American College of Surgeons National Surgery Quality Improvement Project (NSQIP) data available at the institution. They identified a cohort of 177 patients, 79% of whom were reviewed for pain issues at 1 year.

The study focused on postoperative pain during the first year following open cVHR. The investigators looked at how patients registered postoperative discomfort, risk factors that predicted greater utilization of the health system for pain-related complaints, and how often complaints of chronic pain resulted in an actionable diagnosis.

All postop encounters in the year after surgery were documented, including the sequence of events in response to pain complaints. In addition, the investigators recorded “instances in which a diagnosis resulted from such actions and whether the diagnosis was actionable, meaning it led to a specific intervention that was expected to alleviate the pain.”

Of the 177 patients, 91 patients made an unsolicited call, clinic visit, or ED visit for pain issues. For 38 patients in this group, action was taken (additional prescription, imaging ordered, ED workup recommended or undertaken). For the other 53, no action was taken. From each group, some cases resolved because of further intervention, and some cases resolved without further action. Mesh use and preoperative pain scores were predictors of postop pain, but not age, ethnicity, sex, or other comorbidities. But 38 (21%) patients continued to have pain that was not resolved at 1 year, 32 of which had no actionable diagnosis.

The study was retrospective and limited by inclusion of visits and calls only to the surgical services and not to other medical services or physicians. Pain complaints were subjective and levels of severity were not recorded.

The investigators concluded that estimates of the number of patients who have chronic pain after cVHR do not capture the level of health care resource utilization for this problem. Patients experiencing postop pain make unscheduled calls or visits to the clinic or ED, and many do so repeatedly without receiving an actionable diagnosis. “A cost analysis specific to treating postoperative pain for 1 year would provide a better understanding of the magnitude of the problem. Subjective complaints of pain in the year following cVHR are frequent and represent a hidden driver of resource utilization which must be better understood to achieve optimal, cost effective care.”

The authors declared no conflicts of interest.

acssurgerynews@frontlinemedcom.com

SOURCE: DeLong CG et al. Am J Surg. 2018. doi: 10.1016/j.amjsurg.2018.01.030 .

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