OBJECTIVES: Several studies have reported on the ability to reduce post-operative pain following Inguinal Hernia repair by self-fixating mesh.  Our study examines the overall cost increases when post operative pain following Inguinal Hernia Repair is significant enough to be reported by an ICD-9 diagnosis code. METHODS: The Premier Perspective™ Database (PPD) was used to track hospital costs associated with an outpatient Inguinal hernia repair between January, 2008 through June, 2010.  ICD-9 diagnosis codes were used to further identify patient with the presence of acute or chronic post operative pain.  For post discharge pain management strategies and costs we sponsored market research with 30 surgeons who perform Inguinal Hernia repair surgery.  Responses were collected to specific pain management strategies employed, and average per patient costs when patient reported pain was mild, moderate, and severe. RESULTS: A total of 51,108 patients undergoing outpatient Inguinal Hernia repair were identified in the PPD during our study timeframe.  An ICD-9 diagnostic code representing acute or chronic pain was present in 228 discharges.  The mean cost per discharge for patients with diagnosis of acute/chronic pain was $3,309, compared to $2,910 for patients without the diagnostic of pain.   Eighty percent of the physicians surveyed reported they would prescribe pain therapy with a cost of less than $ 100.00.  For moderate pain the breakdown was 70% less than $100.00 and for severe pain 44% indicated the costs would be less than $100.00. CONCLUSIONS: The management of pain following Inguinal Hernia repair increase the pre- and post- discharge costs to the hospital, insurers and patients.  In addition, costs appear to increase in relation to the severity of the pain reported.  Inguinal hernia repair techniques which result in reduced post operative pain such as using self fixating mesh have the potential to reduce the costs associated with Inguinal Hernia repair.