Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients

• Single intuition, single surgeon experience of inguinal hernia repair at the VA · 99% male, 73% Caucasian, 60.4 ± 1.4 years old, BMI = 26.7 ± 4.2 Kg/m2.
• Morbidity was 11.9%. The most common complication was urinary retention (2.3%).
• Inguinodynia, recurrence, and a metachronous hernia rate = 1.5%, 0.8%, and 12%.

BackgroundThe present single-institution, single-surgeon experience interrogated morbidity as well as predictors of inguinodynia, recurrence, and metachronous hernias in 953 consecutive inguinal herniorrhaphies between 2005 and 2015.MethodsData were prospectively collected and retrospectively analyzed from patient medical records at the VA North Texas Health Care System.ResultsNinety-nine percent of our patients were male, 73% Caucasian, 60.4 ± 1.4 years old, body mass index = 26.7 ± 4.2 kg/m2. Overall morbidity was 11.9%. The most common complication was urinary retention (2.3%). Inguinodynia and recurrence occurred at a rate of 1.5% and .8%, respectively. If a patient had a hernia repair, he had a 12% chance of needing a contralateral repair within 7.6 years. Younger age (odds ratio [OR], .96; 95% confidence interval [CI], .91 to 1.0), current history of smoking (OR, 5.3; 95% CI, 1.3 to 22.3), and a previous contralateral hernia repair (OR, 5.5; 95% CI, 1.2 to 25.0) were independent predictors of inguinodynia. A direct hernia was associated with recurrence (45% vs 100%; P = .02). Current smoking was an independent predictor of recurrence (OR, 5.4; 95% CI 1.0 to 29.3). Age (55- to 75-year old; OR, 2.0; 95% CI, 1.1 to 3.9), age (>75-year old; OR, 2.6; 95% CI, 1.1 to 6.1), an indirect hernia repair (OR, 1.9; 95% CI, 1.2 to 3.1), a pantaloon hernia repair (OR, 2.0; 95% CI, 1.0 to 3.8), and current consumption of alcohol (OR, 1.6; 95% CI, 1.0 to 2.5) were independent predictors of a metachronous hernia.ConclusionsThe following study presents several factors predictive of outcomes in patients with inguinal hernias that might be useful in preventing complications and providing informed consent to this patient population.