Improving How Hernia Surgery is Performed
It Includes Avoiding the Need for Opioid Medication
.
Not only do some patients become addicted to these medications—with many Americans dying as a result—but all patients suffer the side effects of remaining groggy and becoming constipated. These side effects hold people back from recovering after surgery.
In 2017, a study appeared in Annals of Surgery, a respected journal, that stated a clear problem: opioids were being over-prescribed to patients having hernia surgery. That got the attention of Americas Hernia Society Quality Collaborative (AHSQC), a group that is committed to improving the care delivered to those with hernias. “There is data that, if surgeons prescribe fewer opioid pills, their patients will take fewer,” says Michael Reinhorn, MD, MBA, of Boston Hernia. “But if surgeons prescribe more, their patients take more.”
The AHSQC launched the Opioid Reduction Initiative and asked Dr. Reinhorn to serve as Chair of its Opioid Reduction Task Force. “We decided to partner with our patients to set realistic expectations about post-surgical pain and reduce the number of opioid pills we prescribe,” says Dr. Reinhorn. “We’ve carefully followed our patients to see how their recovery proceeds and whether or not they take opioids for pain.”
At Boston Hernia, patients receive counseling on how to avoid the use of opioids. “We suggest our patients take Tylenol and Advil together and apply ice for 20 minutes at a time if they’re having a bit more pain,” notes Lauren Ott, PA-C. “We tell them they will be sore for the first three days, but as long as they can sleep and go for a walk, they should not be taking opioids.”
The result? More than 70% of Boston Hernia patients use no opioid medications after their surgery.
At the AHSQC Annual Summit in December 2019, Dr. Reinhorn oversaw the Opioid Reduction Task Force session, where data showed that in many patients who have inguinal hernia surgery performed as an open procedure—as is done at Boston Hernia—take fewer opioids after surgery. There is still work to be done to understand all the factors that go into low opioid use. The Task force and attendees identified that opioids should play a second or third tier role in a complete multi-modal postoperative pain management regimen. “I am proud to say that, at the AHSQC Summit, 90% of the surgeons agreed to change their behavior and committed to prescribing 10 or fewer opioid pills, while instituting multi-modal treatment programs” says Dr. Reinhorn.
Progress will continue, with Dr. Reinhorn and Boston Hernia leading the way by influencing other providers.
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. He started his practice as a general surgeon in 2001, and in 2012 he transitioned to focus on the care of hernia patients. In 2018, he co-founded Boston Hernia, an ambulatory surgery practice focused exclusively on hernia surgery. In 2020, Dr. Nora Fullington was recruited from her work as a general surgeon, where she performed hundreds of laparoscopic hernia repairs, to Boston Hernia where she was intensively trained by Dr. Reinhorn in the open preperitoneal and Shouldice techniques. Together with their physician assistant team, they perform approximately 800 hernia surgeries every year. Both surgeons offer a tailored approach for each patient, taking into account individual patient factors to decide if surgery is recommended or not, what type of repair (open, laparoscopic, mesh, non-mesh) is best, and what type of anesthesia is safest. At Boston Hernia, our focus is on each individual patient and continuously improving our own surgical techniques and outcomes. We do this by participating in various hernia societies, studying our own outcomes through a national database, and publishing our data to influence the care of hernia patients nationally and internationally. Boston Hernia is an affiliate practice of the Mass General Brigham system. In addition to operating at Newton-Wellesley Hospital, a Mass General Brigham Hospital, we offer care at ambulatory surgery centers in Waltham, MA and Derry, NH.