Impact of Abdominal Wall Hernias and Repair on Patient Quality of Life

Cherla, Deepa V.; Moses, Maya L.; Viso, Cristina P.; Holihan, Julie L.; Flores-Gonzalez, Juan R.; Kao, Lillian S.; Ko, Tien C.; Liang, Mike K.

doi:10.1007/s00268-017-4173-6

Cited by 42 publications

(20 citation statements)

References 25 publications

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“…Survey responses are normalized to a scale ranging from 1 (poor) to 100 (perfect), with normal abdominal wall quality of life being 80 or greater. The minimal clinically important difference is 7 for a minor change and 14 for a major change 910. Preoperative pain scores were assessed with a visual analog scale ranging from 0 (no pain) to 10 (worst possible pain); the minimal clinically important difference is 1 11…”

Section: Methodsmentioning

confidence: 99%

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Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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ObjectiveTo determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair.DesignPragmatic, blinded randomized controlled trial.SettingMultidisciplinary hernia clinics in Houston, USA.Participants124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019.InterventionsRobotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59).Main outcome measuresThe primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat.ResultsPatients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair.ConclusionThis study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs.Trial registrationClinicaltrials.gov NCT03490266.

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Section: Methodsmentioning

confidence: 99%

“…The minimal clinically important difference is 7 for a minor change and 14 for a major change. 9 10 Preoperative pain scores were assessed with a visual analog scale ranging from 0 (no pain) to 10 (worst possible pain); the minimal clinically important difference is 1. 11 …”

Section: Methodsmentioning

confidence: 99%

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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“…A generic validated QOL scale should be more acceptable to population and observers and should be consistent and acceptable in both short and long term follow up. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] Literature review has showed that, it is best to use a generic scale with a disease specific scale along with a validated pain scale that can cover the immediate postoperative period. 8,13,14 Pain scores should be used in the peri-operative period to determine if patient has developed any acute pain or his pre-operative pain is continuing and becoming a chronic pain.…”

Section: Discussionmentioning

confidence: 99%

“…Time frame for follow up is the most diverged subject in the literature, where quality of life was measured as soon as next day of surgery to up to five years. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] No consistency was found in the follow up period and in different studies it ranges from days to years. Literature review also did not help to conclude the best time for follow up.…”

Section: Discussionmentioning

confidence: 99%

Review of currently used standardized measures of quality of life after ventral incisional hernia repair: systematic review

Majeed

Chauhan

2019

Int Surg J

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After advancements in surgical and anaesthetics expertise and increased life spans among patients with complex abdominal surgeries, clinicians are left with the next main challenge, to how to improve the quality of life in patients with incisional hernia resulted from previous complex abdominal surgeries. To date there is no consensus over the choice of instrument and time frame for its administration in the literature. The aim of this review was to search for the current literature on measurement of quality of life in patients with ventral incisional hernia repair and to explore how effective each QOL instrument was for measuring impact on quality of life after ventral incisional hernia repair. In accordance with PRISMA guidelines two independent clinicians searched for Mesh and specific terms related to quality of life in patients with ventral incisional hernia. Search was made on PubMed, Embase and other research databases. Trial registries were searched for any published or unpublished trials. Literature search came up with 461 articles. After scanning and removal of duplication, 200 articles were subjected to inclusion and exclusion criterion and 59 articles were selected for qualitative analysis. Different scales for the measurement of quality of life after ventral incisional hernia repair were found. The incidence of incisional hernia itself was found to be the biggest determinant of poor quality of life, regardless of timescale of follow up and type of surgery performed. No single instrument was found to be complete enough to address the wide-ranging health-related quality of life issues in patients after incisional hernia repair.

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“…It was only used for QOL assessment in two of the included studies, both in the last 5 years. Cherla et al [ 17 ] assessed QOL using AAS in patients with AHW undergoing reconstruction.…”

Section: Quality-of-life Assessment Toolsmentioning

confidence: 99%

Measuring quality of life in patients with abdominal wall hernias: a systematic review of available tools

Grove

Muirhead

Parker

et al. 2020

Hernia

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Introduction Abdominal wall herniation (AWH) is an increasing problem for patients, surgeons, and healthcare providers. Surgical-site specific outcomes, such as infection, recurrence, and mesh explantation, are improving; however, successful repair still exposes the patient to what is often a complex major operation aimed at improving quality of life. Quality-of-life (QOL) outcomes, such as aesthetics, pain, and physical and emotional functioning, are less often and less well reported. We reviewed QOL tools currently available to evaluate their suitability. Methods A systematic review of the literature in compliance with PRISMA guidelines was performed between 1st January 1990 and 1st May 2019. English language studies using validated quality-of-life assessment tool, whereby outcomes using this tool could be assessed were included. Results Heterogeneity in the QOL tool used for reporting outcome was evident throughout the articles reviewed. AWH disease-specific tools, hernia-specific tools, and generic tools were used throughout the literature with no obviously preferred or dominant method identified. Conclusion Despite increasing acknowledgement of the need to evaluate QOL in patients with AWH, no tool has become dominant in this field. Assessment, therefore, of the impact of certain interventions or techniques on quality of life remains difficult and will continue to do so until an adequate standardised outcome measurement tool is available.

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Impact of Abdominal Wall Hernias and Repair on Patient Quality of Life

Abstract: VHR can improve 1-year postsurgical AW-QOL to levels similar to that of the general population. The MCID of the modified AAS is 7.6 points. Patients with high baseline scores should be counseled about the lack of potential benefit in QOL from elective VHR.

Cited by 42 publications

References 25 publications

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Review of currently used standardized measures of quality of life after ventral incisional hernia repair: systematic review

Measuring quality of life in patients with abdominal wall hernias: a systematic review of available tools

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