Page 58 - herina surgery and possible lawsuits

Chronic pain to Age and employment status:

• There were very few studies, which relate the chronic pain with age. For that the
studies have divided the patient’s age in three groups young age (0-39 yrs.), middle
age (40-60 yrs.) and old age (>61 yrs.)

• Bay-Nielsen et al. found 28.7% had chronic pain and the relation to young, middle
and old age groups were 39.7%, 33.2% and 17.6% respectively with functional
impairment rate of 11.2% and 6.1% in young and old age groups. [13] they further

conclude that pain was more common in patients younger than 40 years of age .[116]
• Poobalan study also found 30% chronic pain incidence and the relation of chronic

pam to age <40 and > 60 yrs was 58% and 15%. [117] Finding suggest that chronic
pain and its severity is more in young patients than old age, and pam also decreased
with increasing age. Patients with full time employment were more likely to have
chronic pain than retired (P=0.001).[l 17]

Pain association to Sex:

• Though the inguinal hernias are not common in the females, Bay-Nielsen had
included female gender for nationwide study, found 38% incidence of chrome pain m
female compared to 28% in male (P<0.05)[13]. Danish hernia database study on
women found 4.3% reoperation rate in compare to 3.1% in men and the reason for

reoperation was femoral hernia (41.5%)[118],

Hernia presentation and pain:

• Alfien et al. had studied 955 patients with 1050 total repairs, 55% on right side and
45% on left side. Alfieri et al. had reported moderate to severe pain at 6 months in
2.0% (16/797) umlateral and 2.8% (5/176) bilateral hernia repairs (P=0.16) Alfien et
al. had reported moderate to severe pam at 6 months in 1.25% (4/321) direct, 2.3%

(15/653) indirect and 3.5% (1/32) pantaloon hernia repairs (P=0.67) [15],
• As per Nyhus classification the study of Fitzgibbon had indirect inguinal hernias

comprised 53% of hernias (type 1=12%, type 2=29%, type 3b=12%) and direct
inguinal hernias (type 3a) 41%.[53]

Pre operative pain and chronic pain:
Only few studies had reported relation between preoperative pam and postoperative chronic
pain.

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