Perioperative celecoxib plus dexamethasone after inguinal hernia repair is linked to lower one-year recurrence, with a stronger association in obese patients

Perioperative celecoxib plus dexamethasone was independently associated with lower one-year recurrence risk after inguinal hernia repair (HR=0.45, 95% CI: 0.24-0.84, P=0.011). Prior understanding held that hernia recurrence is common especially in obese individuals, but the influence of perioperative analgesics on long-term outcomes across BMI ranges was unknown; this study links a commonly used perioperative analgesic regimen directly to the long-term outcome of one-year recurrence. Based on retrospective clinical data from January 2021 to December 2024, with 1:1 nearest-neighbor propensity score matching yielding 280 patients per group, good baseline balance after matching (P>0.05), and multivariable Cox regression; the overall one-year recurrence rate was 5.0% (28/560).

A significant interaction between treatment and BMI was observed (P=0.032), with a stronger association in obese patients (HR=0.32, 95% CI: 0.14-0.71) and a non-significant association in non-obese patients (HR=0.68, 95% CI: 0.31-1.52). Beyond reporting an overall association, the study tested effect differences by BMI stratum, suggesting the value of the perioperative analgesic regimen may be concentrated in the obese population that carries higher recurrence risk. Interaction test P=0.032, with stratified results presented as hazard ratios and 95% confidence intervals; the non-obese subgroup confidence interval crosses 1, indicating the association in that subgroup remains uncertain.

The study group also showed lower acute pain scores, reduced postoperative nausea and vomiting (P<0.001), lower chronic pain risk at three months (aOR=0.42, 95% CI: 0.23-0.78, P=0.006), earlier return to daily activities and better quality of life (both P<0.001), with comparable complication rates between groups. The study covers multiple outcome layers including short-term symptoms, chronic pain, functional recovery and quality of life, indicating that alongside the recurrence association the regimen accompanies improved perioperative experience and recovery metrics without an observed increase in complications. Secondary outcomes used multivariable logistic regression to assess chronic pain risk factors, with other measures reported as between-group comparisons and P values; complication rates were comparable between groups.

The results apply to adult patients undergoing inguinal hernia repair between January 2021 and December 2024 whose clinical data were available, particularly the obese population at higher recurrence risk; for clinicians, it suggests perioperative celecoxib plus dexamethasone as a candidate regimen addressing both analgesia and potential recurrence risk reduction, warranting prospective BMI-stratified validation. For researchers, it offers an analytic framework using BMI as an effect modifier that can inform intervention trials targeting obese patients.

As a retrospective study, unmeasured confounding may exist between the treatment and control groups, and propensity score matching can only balance measured variables; the non-obese subgroup confidence interval crosses 1, so the direction and magnitude of the association in that subgroup remain to be confirmed; the specific definition of obesity, composition of surgical approaches, completeness of follow-up and details of recurrence ascertainment are not presented within this reading scope, all of which affect interpretation; moreover, this reading is of an incomplete text without figures or supplementary materials, so the above numbers and conclusions should be checked against the complete original version.