Abstract
BackgroundWith the development of prosthetic mesh and tension free techniques, the recurrence rate following inguinal hernia repair has been reduced, and hernia outcomes research should focus on post-operative quality of life and potential complications.Study designA novel hernia quality of life assessment instrument, HERQL, was developed. The HERQL questionnaire comprises a 4-item summative pain score measuring pain and discomfort resulting from various strenuous activities. Symptomatic and functional domains, as well as post-operative satisfaction are evaluated as well.ResultsA total of 386 HERQL surveys were completed by 183 patients with inguinal hernias. Internal consistency reliability of the summative pain score was satisfactory, with a Cronbach’s alpha of 0.85. Criterion validity was examined by concomitant assessment of the pain/discomfort and health impact subscales of the EQ-5D questionnaire, with substantial to moderate correlations. Pre-operative patients reported more severe hernia protrusion, more pain during mild to heavy exercise, and worse activity restriction and health impairment than the follow-up patients, indicating clinical validity. The conceptual structure of the HERQL demostrated the causal relationship between the formative symptomatic subscales and the reflective functional status indicators. Repeated measurement of the summative pain scores revealed an estimated time effect of -1.63, which was the rate of change in the summative pain score across the pre-operative, immediately post-operative, and follow-up 3-month periods suggesting the clinical responsiveness of the HERQL.ConclusionsThis study will facilitate inguinal hernia outcomes research and enhance the quality of care for this common disease by providing a validated HERQL instrument with enhanced sensitivity.
Highlights
Hernia repair is one of the most common procedures performed by surgeons worldwide
A total of 386 HERQL surveys were completed by 183 patients with inguinal hernias
The conceptual structure of the HERQL demostrated the causal relationship between the formative symptomatic subscales and the reflective functional status indicators
Summary
Hernia repair is one of the most common procedures performed by surgeons worldwide. With the advancements in prosthetic mesh and improvements in tension free repair, the recurrence rate following hernia repair has been reduced dramatically, and hernia outcomes research should focus on post-operative quality of life and potential complications such as chronic nondisabling pain [1,2,3,4,5,6,7].Quality of life research in hernia patients usually utilizes generic instruments, which reduces the measurement sensitivity and limits the clinical applications. With the advancements in prosthetic mesh and improvements in tension free repair, the recurrence rate following hernia repair has been reduced dramatically, and hernia outcomes research should focus on post-operative quality of life and potential complications such as chronic nondisabling pain [1,2,3,4,5,6,7]. The Carolinas Comfort Scale (CCS) was developed for patients undergoing mesh repairs and was validated in abdominal wall/groin hernias with both laparoscopic and open repairs [10], and a preference for the CCS rather than the generic SF-36 was reported. With the development of prosthetic mesh and tension free techniques, the recurrence rate following inguinal hernia repair has been reduced, and hernia outcomes research should focus on post-operative quality of life and potential complications
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