BMI-stratified predictors of recurrence after inguinal hernia repair: The role of perioperative celecoxib and dexamethasone

Background: Inguinal hernia recurrence after repair is common, especially in obese individuals, but the influence of perioperative analgesics on long-term outcomes across body mass index (BMI) ranges is unknown. Objectives: This study assessed whether perioperative celecoxib and dexamethasone are associated with inguinal hernia recurrence and if this varies by BMI. Methods: This retrospective study analyzed clinical data from patients undergoing inguinal hernia repair between January 2021 and December 2024. Using 1:1 nearest-neighbor propensity score matching (PSM), 280 patients who received perioperative celecoxib and dexamethasone (study group) were compared with 280 who did not (control group). The primary outcome was hernia recurrence within one-year post-surgery, confirmed by clinical examination or imaging. Secondary outcomes included 72-hour pain scores, postoperative nausea and vomiting, chronic pain at three months, complications, recovery parameters and quality of life measures. Predictors of recurrence, including treatment, BMI category and their interaction, were assessed using multivariable Cox regression. Multivariable logistic regression was applied to evaluate risk factors for chronic pain. Results: PSM leads to a good balance of baseline characteristics between the two groups (P>0.05). The overall one-year recurrence rate was 5.0% (28/560). Multivariable analysis revealed that perioperative celecoxib and dexamethasone were independently associated with lower recurrence risk (HR=0.45, 95% CI: 0.24-0.84, P=0.011). A significant interaction with BMI was noted (P=0.032), indicating a stronger association in obese (HR=0.32, 95% CI: 0.14-0.71) than non-obese patients (HR=0.68, 95% CI: 0.31-1.52). The study group also demonstrated lower acute pain scores, reduced postoperative nausea/vomiting (P<0.001) and decreased chronic pain risk (aOR=0.42, 95% CI: 0.23-0.78, P=0.006). They returned to daily activities sooner and reported better quality of life (both P<0.001). Complication rates were comparable between groups. Conclusion: Perioperative celecoxib and dexamethasone were associated with reduced hernia recurrence, particularly in obese patients and improved pain control without increased complications.