Identifying patients at risk for urinary retention following inguinal herniorrhaphy: a single institution study.

PURPOSE: We aim to identify patients at risk for post-operative urinary retention (POUR) and factors associated with POUR. METHODS: Males who underwent inguinal hernia repair (IHR) from June 2010 to September 2014 at a single institution were grouped according to the presence (symptomatic) or absence (asymptomatic) of preoperative urogenital symptoms (UGS). Patients ≤ 18 years of age were excluded. POUR was defined as the need to catheterize a patient who had not voided 6 h after surgery. Data were examined using IBM SPSS v23.0. RESULTS: Of the 60 asymptomatic and 30 symptomatic patients identified, no differences were seen in age (55 vs. 65, p = 0.13), length of stay > 1 day (3% vs. 13%, p = 0.09), bilateral inguinal herniation (23% vs. 23%, p = 1.00), or laparoscopic approach (70% vs. 69%, p = 1.00); however, significant differences were seen in POUR (5% vs. 27%, p = 0.01) and α-blocker utilization (50% vs. 80%, p = 0.01). When age-matched, neither POUR (10% vs. 27%, p = 0.10) or α-blocker utilization (57% vs. 80%, p = 0.05) significantly differed between asymptomatic and symptomatic patients, respectively. Logistic regression analysis demonstrated that only bilateral inguinal herniation (OR 6.55, p = 0.03) and symptoms (OR 6.78, p = 0.02) were associated with POUR. Asymptomatic patients with a unilateral hernia have a 4.3% risk of POUR, whereas symptomatic patients with a bilateral inguinal hernia have at 57.1% risk. CONCLUSIONS: We demonstrate that bilateral inguinal herniation and UGS independently increase the risk of POUR, whereas α-blockers do not. For the general surgical population, α-blockers should not be routinely prescribed to all patients and instead should be limited to high-risk patients.

Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair.

PURPOSE: Studies comparing laparoscopic (LIHR) vs. open inguinal hernia repair (OIHR) have shown similar recurrence rates but have disagreed on perioperative outcomes and costs. The aim of this study is to compare laparoscopic vs. open outcomes and costs. METHODS: The National Surgical Quality Improvement Program (NSQIP) was used to compare durations of surgery, anesthesia time, and length of stay (LOS). The University HealthSystem Consortium (UHC) was used to review the cost and complications between approaches. Patients were matched on demographics, year of procedure and surgical approach between datasets for statistical analysis. RESULTS: A sample of 5468 patients undergoing OIHR (N = 4,693) or LIHR (N = 775) was selected from UHC from 2008-2011. An identical number of patients from NSQIP were matched to those from UHC resulting in a total of 10,936 records. LIHR patients had shorter duration of wait from admission to operation (p < 0.05). Conversely, LIHR patients had longer operating time (p < 0.05), duration of anesthesia (p < 0.05), and time in the operating room (p < 0.05).Overall complication rate was higher in open (3.1 vs. 1.8 %, p < 0.05). Cost favored open over LIHR ($4360 vs $5105). The cost discrepancy mainly stemmed from LIHR supplies ($1448 vs. $340; p < 0.05) and OR services ($1380 vs. $1080; p < 0.05). CONCLUSION: This study demonstrates the LOS and perioperative outcomes were superior in the LIHR group; however, the overall cost was higher due to the supplies. Advancement in technology, surgeons' skill level and preference of supplies are all factors in decreasing the overall cost of LIHR.

Pain control for laparoscopic colectomy: an analysis of the incidence and utility of epidural analgesia compared to conventional analgesia.

PURPOSE: The aim of this study was to compare short-term outcomes between epidural analgesia and conventional intravenous analgesia for patients undergoing laparoscopic colectomy. This paper uses a large national database to add a current perspective on trends in analgesia and the outcomes associated with two analgesia options. Our evidence augments the opinions of recent randomized controlled trials. METHODS: The University HealthSystem Consortium, an alliance of more than 300 academic and affiliate institutions, was reviewed for the time period of October 2008 through September 2014. International Classification of Disease 9th Clinical Modification codes for laparoscopic colectomy and epidural catheter placement were used. RESULTS: A total of 29,429 patients met our criteria and underwent laparoscopic colectomy during the study period. One hundred and ten (0.374%) patients had an epidural catheter placed for analgesia. Baseline patient demographics were similar for the epidural and conventional analgesia groups. Total charges were significantly higher in the epidural group ($52,998 vs. $39,277; p < 0.001). Median length of stay was longer in the epidural group (6 vs. 5 days; p < 0.001). There was no statistical difference between the epidural and conventional analgesia groups in death (0 vs. 0.03%; p = 0.999), urinary tract infection (0 vs. 0.1%; p = 0.999), ileus (11.8 vs. 13.6%; p = 0.582), or readmission rate (9.1 vs. 9.3%; p = 0.942). CONCLUSION: Compared to conventional analgesic techniques, epidural analgesia does not reduce the rate of postoperative ileus, and it is associated with increased cost and increased length of stay. Based on our data, routine use of epidural analgesia for laparoscopic colectomy cannot be justified.