General Surgery Resident Prisma Health-Upstate , United States
Objectives: Recent data on opioid consumption indicates that patients typically require far less than is prescribed. *** adopted standardized postoperative prescribing after hernia repair and began tracking patient reported opioid utilization. The aim of this study is to further evaluate patient opioid use after hernia repair in order to guide future prescribing.
Methods: All patients undergoing primary ventral (umbilical and epigastric), incisional and inguinal hernia repair between February and November 2019 (including preciously analyzed data from February and May 2019) were reviewed. All opioid prescriptions that were received from pharmacies was able to be account for by utilizing SCIPTS PMP. Patients reported the number of opioid pills taken at their first postoperative visit and documented either in the progress note or in the Americas Hernia Society Quality Collaborative (AHSQC) patient reported outcomes (PRO) questionnaire. All demographic, operative, and outcomes data were captured prospectively in the AHSQC. Opioid use reported as milligram morphine equivalents (MME).
Results: A total of 389 surgeries were performed during the study period, and 285 had patient reported opioid use for analysis. Within these groups, opioid use was reported in 79 out of 103 patients having undergone inguinal hernia repair, 36 out 44 primary ventral hernia repairs, and 170 out of 242 incisional hernia repairs. No opioid use was reported in 67% of inguinal hernias (53 patients), 69% of primary ventral hernias (25 patients), and 53% of incisional hernias (91 patients). Inguinal hernia patients consumed a mean of 11.9 MME, primary ventral patients 22.63 MME, and incisional hernia patients 84.74 MME. The average prescribed MME for patients undergoing inguinal hernia repair was 69.15 MME, 68.33 MME for ventral hernia repair, and 288.58 MME for incisional hernia repair.
Conclusion: Patients require little to no opioid after primary ventral and inguinal hernia repair. This data further demonstrates that opioid-free surgery is feasible in regards to ventral and inguinal hernia repair. Incisional hernia is more heterogenous, but the majority of patients still required less opioids than previously anticipated and vastly less than the amount of opioids that are frequently prescribed postoperatively when a prescribing protocol is not in place.
