Patient-reported outcomes in hernia repair

Background The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for groin hernia repair. Methods In two centres for short-stay surgery all patients referred for hernia repair were surveyed between August 1999 and January 2002. Patients reported on health-related quality of life (SF-36), symptoms ( Hernia Symptom Checklist, HSCL) and other indicators pre-operatively (T0) and 14 days (T1) and 6 months post-operatively (T2). Three of the eight SF-36 subscales ( physical functioning, bodily pain, and role physical) and the HSCL at T2 were considered as main outcome indicators. The main outcomes were analysed by generalized linear models with regard to predictors. Results At T0 a total of 342 hernia patients were included. The response rate at T2 was 54.1% (92.4% males, 58.6 years of age). At T2 only 21.1% did not report complaints (i.e. haematoma, pain, numbness) post-operatively. The overall positive course is reflected by the HSCL: from 32.4% pre-operatively, it rises slightly to 38.5% at T1 and decreases to 10.6% at T2 (T0-T2: P < 0.001). The SF-36 subscales "physical functioning", "bodily pain", and "role physical" showed the same course over time ( slight decrease of health-related quality of life at T1 and large increase at T2). The main patient-reported outcomes were mainly influenced by the pre-operative level, age, and self-reported post-operative complaints. Conclusion The low response rate was mainly due to non-delivery of questionnaires at T1 during the regular post-operative visit by the operating physician. Though non-response occurs under conditions of routine care, meaningful information was gained which should be used for quality improvement activities. Because the pre-operative level is a major determinant of the post-operative health outcomes, the prospective pre-post measurement should be standard, in case institutional comparisons are intended.