Background & Aims

Ventral hernia (VH) are common abdominal wall defects. While not always symptomatic, they can lead to complications such as pain, bowel obstruction, and reduced quality of life. Surgical repair aims to address symptomatic VHs and potentially prevent future complications, thus improving long-term patient outcomes.1,2 While surgical indications seem straightforward, the long-term benefits compared to conservative management remain unclear.3,4,5 This study aims to investigate whether surgical intervention for VH improves patient outcomes compared to no surgical intervention regarding physical therapy needs, opioid misuse, lumbopelvic pain diagnosis, and impaired abdominal wall function over a 5-year period.

Methods

This retrospective study utilized the TriNetX Research Network. TriNetX is an anonymized, HIPAA compliant, global federated health research network that provides electronic medical records (EMR) across health care organizations (HCOs) from several countries. Data was extracted from patients across 86 HCOs. Administrative coding data were used to identify patients and our selected outcomes. The control cohort were individuals with VH without surgical repair after diagnosis. The comparison cohort were individuals with VH and surgical repair within 12 months of diagnosis. Cohorts were balanced based on demographics and confounding diagnoses using a 1:1 propensity score matching. Data analyses included measures of association and Kaplan-Meier analysis (disease-free rate at 5 years without outcomes). Outcomes were physical therapy evaluation, opioid misuse, lumbopelvic pain diagnosis, and constipation.

Results

Propensity score matching yielded 139,255 patients per cohort. The data set had a mean age of 53 (21-70) years old. The dataset was balanced between males and females, with a small percentage unknown. Most patients were white (65.54%), followed by Black or African American (14.31%). Compared to the control group, patients who underwent surgery had a higher risk of participating in a physical therapy evaluation (OR: [1.15], 95% CI: [1.11, 1.18]). Opioid misuse was also more frequent in the surgical group (OR: [1.09], 95% CI: [1.04, 1.14]). Kaplan-Meier analysis revealed a significantly higher 5-year disease-free rate of lumbopelvic pain diagnosis ([70.06%] vs [68.54%], p < 0.0001) and constipation ([86.68%] vs [85.27%], p < 0.0001) in the surgical group compared to controls.

Conclusions

This study explores long-term outcomes for VH patients undergoing surgery compared to those without surgery. While surgery led to more physical therapy use and slightly higher opioid misuse, it offered significant benefits. Surgery had a lower risk of developing lumbopelvic pain and constipation over 5 years. This suggests surgery may improve long-term outcomes despite rehabilitation needs and potential for pain medication use. Limitations exist as the study relied on coding, which could be inaccurate. Additionally, the increased physical therapy use in the surgical cohort could indicate a higher rate of postoperative complications requiring intervention. Research is needed to understand the specific reasons behind the higher physical therapy use, the parameters utilized within rehabilitation postoperatively and potential link to complications. Overall, the study suggests surgery offers advantages for long-term pain and function, but a more nuanced understanding of recovery is needed.

References

1. Ramaswamy A. Preoperative Optimization for Abdominal Wall Reconstruction.?Surg Clin North Am. 2023;103(5):917-933. doi:10.1016/j.suc.2023.04.022

2. Timmer AS, Claessen JJM, Boermeester MA. Risk Factor-Driven Prehabilitation Prior to Abdominal Wall Reconstruction to Improve Postoperative Outcome. A Narrative Review. J Abdom Wall Surg. 2022 Sep 16;1:10722. doi: 10.3389/jaws.2022.10722. PMID: 38314165; PMCID: PMC10831687

3. Adams ST, Bedwani NH, Massey LH, et al. Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence.?Hernia. 2022;26(3):701-714. doi:10.1007/s10029-022-02562-5

4. Pezeshk RA, Pulikkottil BJ, Mapula S, et al. Complex Abdominal Wall Reconstruction: A Novel Approach to Postoperative Care Using Physical Medicine and Rehabilitation.?Plast Reconstr Surg. 2015;136(3):362e-369e. doi:10.1097/PRS.0000000000001532

5. Renshaw S, Peterson R, Lewis R, et al. Acceptability and barriers to adopting physical therapy and rehabilitation as standard of care in hernia disease: a prospective national survey of providers and preliminary data.?Hernia. 2022;26(3):865-871. doi:10.1007/s10029-022-02606-w

Presenting Author

Christopher Keating

Poster Authors

Christopher Keating

PT, DPT

Thomas Jefferson University

Lead Author

Sourav Podder

MD

Thomas Jefferson University

Lead Author

Julia Baran

Thomas Jefferson University

Lead Author

Nicole Dugan

PT

Jefferson Rehabilitation

Lead Author

Sami Tannouri

MD

Thomas Jefferson University Hospital

Lead Author

Francesco Palazzo

MD

Thomas Jefferson University Hospital

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain