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Purpose: Despite efforts to minimize opioid prescribing, outpatient ventral hernia repair (VHR) with mesh remains notoriously painful, often requiring postoperative opioid analgesia. Here, we aim to characterize patterns of opioid prescribing for the heterogenous group of patients and procedures that comprise mesh-based, outpatient VHR., Methods: The Abdominal Core Health Quality Collaborative registry was queried for patients undergoing VHR with mesh who were discharged the same or next day between January 2019 to October 2023. Procedures were broadly classified by approach and mesh location: open, minimally-invasive with intraperitoneal mesh (MIP), and minimally-invasive with retromuscular or preperitoneal mesh (MRPP). Surgeon-reported opioid prescription quantity and patient-reported 30-day consumption data were reviewed., Results: Of 2,795 patients who met inclusion criteria (46.1% open, 22.7% MIP, 31.2% MRPP), approximately 80% of patients consumed ≤ 10 tablets of opioid pain medication (open 87.7%, MIP 78.4%, MRPP 84.2%). For patients who were prescribed ≤ 10 tablets, the median number of unconsumed tablets was 5 (IQR 0-8). For patients who were prescribed > 10 tablets, the median number of unconsumed tablets was 10 or more (open 10 [IQR 2-16], MIP 10 [IQR 2-18], MRPP 12 [IQR 5-16]). The number of tablets consumed was positively correlated with the number of tablets prescribed (Kendall's rank correlation = 0.232, p < 0.001)., Conclusion: Regardless of technique, for outpatient VHR with mesh, the fewer opioid tablets prescribed, the fewer tablets patients consumed. Decreasing the prescription quantity to ≤ 10 tablets, coupled with preoperative patient education, may help minimize excess opioid prescribing while still achieving adequate pain control., Competing Interests: Declarations. Conflict of interest: Kimberly P. Woo, Xinyan Zheng, Amitabh P. Goel, Anthony A. Iacco, Todd S. Harris, and Michael Reinhorn declare that they have no conflict of interest. Rana M. Higgins, MD is a speaker for WL Gore and Intuitive Surgical. Jeremy A. Warren, MD is a consultant for Intuitive Surgical and a speaker Ethicon/Johnson & Johnson. Clayton C. Petro, MD is a consultant for Advanced Medical Solutions, TelaBio, Medtronic, BD, Surgimatix and received an institutional grant from Merck. Ethical Approval: Ethical approval for this study was obtained from the Cleveland Clinic Institutional Review Board (IRB# 19-884). Human and Animal Rights: This article does not contain any studies with human or animal subjects. It is a review of data already collected in a hernia database. Informed Consent: Formal informed consent is not required for this type of study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: While sex differences are known to have a clinically relevant impact on the response to pain therapy, current data are still largely equivocal on sex-specific postoperative pain management. The aim of this study is to determine whether sex predicts differences in pain management in patients undergoing ventral hernia repair (VHR)., Methods: This was a retrospective analysis of prospectively collected data for VHR from the Abdominal Core Health Quality Collaborative. The study population included all opioid-naïve adults, undergoing nonemergent initial management of uncomplicated VHR. Multinominal logistic regression was used to explore if postoperative opioid regimens differed by patient sex., Results: The final study population included 1325 males (mean age 54 y, 86.7% White, 62.9% open repairs, 75.9% mesh) and 827 females (mean age 51, 75.7% White, 52.5% open repairs, 69.5% mesh). Unadjusted analysis showed that an opioid sparing regimen was offered to 62.27% female patients and 66.34% male patients. Adjusted analysis demonstrated female patients were less likely to receive an opioid-sparing pain regimen when compared to male patients (odds ratio = 0.647, 95% confidence interval: (0.46-0.909), P = 0.012)., Conclusions: Despite having a higher analgesic response than their male counterparts, as well as having a significantly lower morphine consumption postoperatively, female patients were less likely to receive an opioid-sparing regimen. These results show that there is a pressing need to educate clinicians on how sex-specific differences in pain and analgesia may affect opioid prescribing practices. Enhancing clinician awareness about sex-specific differences in pain and analgesia could potentially inform better prescribing practices and promote more equitable postoperative care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Despite progress toward curtailing opioid prescribing, physicians are often slow to adopt new prescribing practices. Using the Abdominal Core Health Quality Collaborative (ACHQC), we aimed to demonstrate the ability of a national, disease-specific, personalized registry to impact opioid prescribing., Methods: Using a collaborative and iterative process, a module was developed to capture surgeon opioid prescribing, patient-reported consumption, and risk factors for opioid use. Study reported according to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines., Results: Six months after implementation of the ACHQC opioid module, we assessed participation, prescribing and patient consumption patterns. For ventral hernia repair (VHR; n = 398), 23 surgeons reported prescribing > 20 pills (43%), 11-20 (40%), and < 10 (18%). In contrast, patients (n = 217) reported taking < 10 pills in 65% and only 20% reported taking > 15. For inguinal hernia repair (IHR; n = 443) 37 surgeons reported prescribing > 20 tablets (22%), 11-20 (32%), and < 10 (44%). Patients (n = 277) reported taking < 10 pills in 81% of cases, including 50% reporting zero, and only 13% taking > 15. We identified barriers to practice change and developed a strategy for education, provision of individualized data, and encouraging participation. Surgeon participation has since increased significantly (n = 65 for VHR; n = 53 for IHR), and analysis of the impact of this process is ongoing., Conclusion: Quality improvement requires physician engagement, which can be facilitated by meaningful and actionable data. The specificity of the ACHQC and the ability to provide surgeons with individualized data is a model method to incite change in physician behavior and improve patient outcomes., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: A better understanding of the analgesia needs of patients who undergo common operative procedures is necessary as we address the growing opioid public health crisis in the United States. The aim of this study was to evaluate patient experience with our opioid prescribing practice after elective inguinal hernia repairs., Methods: A prospective, observational study was conducted between October 1, 2015, and September 30, 2016, in a single-surgeon, high-volume, practice of inguinal hernia operation. Adult patients undergoing elective inguinal herniorrhaphy under local anesthesia with intravenous sedation were invited to participate. All patients were prescribed 10 opioid analgesic tablets postoperatively and were counseled to reserve opioids for pain not controlled by nonopioid analgesics. Their experience was captured by completing a questionnaire 2 to 3 weeks postoperatively during their postoperative visit., Results: A total of 185 patients were surveyed. The majority of the participants were males (177, 95.7%) and ≥60 years old (96, 51.9%). Of the 185 patients, 159 (85.9%) reported using ≤4 opioid tablets; 110 patients (59.5%) reported that they used no opioid analgesics postoperatively. None of the patients was taking opioids within 7 days of their postoperative appointment. Of the 147 patients who were employed, 111 (75.5%) reported missing ≤3 work days, 57 of whom (51.4%) missed no work at all. Patients who were employed were more likely to take opioid analgesics postoperatively (P = .049). Patients who took no opioid analgesics experienced less maximum (P < .001) and persistent groin pain (P = .037). Pain interfered less with daily activities (P = .012) and leisure activities (P = .018) for patients who did not use opioids., Conclusion: The majority of our patients reported that they did not require any opioid analgesics, and nearly all of those who thought that they did need opioids used <5 tablets. Our data suggest that for elective inguinal hernia repair under a local anesthetic with intravenous sedation, a policy of low opioid analgesic prescribing is achievable; these findings call for further investigation of how to best prescribe opioid medications to patients after an inguinal herniorrhaphy., (Copyright © 2017 Elsevier Inc. All rights reserved.)