Design and Initial Implementation of HerQLes: A Hernia-Related Quality-of-Life Survey to Assess Abdominal Wall Function

被引:225
作者
Krpata, David M. [1 ]
Schmotzer, Brian J. [2 ]
Flocke, Susan [3 ,4 ]
Jin, Judy [1 ]
Blatnik, Jeffrey A. [1 ]
Ermlich, Bridget [1 ]
Novitsky, Yuri W. [1 ]
Rosen, Michael J. [1 ]
机构
[1] Case Western Reserve Univ, Univ Hosp Case Med Ctr, Case Comprehens Hernia Ctr, Cleveland, OH 44106 USA
[2] Case Western Reserve Univ, Ctr Clin Invest, Cleveland, OH 44106 USA
[3] Case Western Reserve Univ, Dept Family Med & Community Hlth, Cleveland, OH 44106 USA
[4] Case Western Reserve Univ, Dept Epidemiol & Biostat, Cleveland, OH 44106 USA
关键词
COMPONENTS SEPARATION; STRENGTH; OUTCOMES; REPAIR; QUESTIONNAIRE; POSTERIOR;
D O I
10.1016/j.jamcollsurg.2012.06.412
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Success of a surgical intervention is often measured by hard clinical outcomes. In ventral hernia repair (VHR) these include wound morbidity and hernia recurrence. These outcomes fail to account for a surgical intervention's effect on a patient's quality of life (QofL). Our objective was to design a hernia-specific QofL instrument with a focus on abdominal wall function, evaluate its measurement properties, and assess the impact of VHR on QofL using this new instrument. STUDY DESIGN: A 16-question QofL survey tool, HerQLes, was constructed. Patients presenting for elective VHR completed the survey. Rasch modeling was used to evaluate the items; fit statistics, person-item mapping, separation index, and reliability were examined. Associations between baseline characteristics and QofL were assessed. RESULTS: Eighty-eight patients completed the survey before assessment for VHR. Mean age was 57.2 years (+/- 12.4 years), mean American Society of Anesthesiologists score was 2.8 (+/- 0.5), and mean body mass index was 34.9 kg/m(2) (+/- 9.3 kg/m(2)). Based on Rasch modeling, 12 of 16 items met model fit criteria. The 4 poorly fitting items were eliminated from further analysis. The 12 items retained have good internal consistency reliability (0.86). On a 0- to 100-point scale, mean QofL score was 47.2 (+/- 15.6). Patients with higher grade hernias had lower HerQLes scores (p = 0.06). Patients showed significant improvement in abdominal wall function and QofL 6 months after VHR (p < 0.01). CONCLUSIONS: Quality-of-life is an important component of surgical management of ventral hernias. The 12-question QofL survey, HerQLes, is reliable and valid. At baseline, patients with more complex hernias tended to have a decreased abdominal wall function and QofL. Six months after surgical repair, HerQLes scores change in the predicted direction. We believe HerQLes is potentially a valuable tool to assess patient-centered abdominal wall functional improvements after VHR. (J Am Coll Surg 2012;215:635-642. (c) 2012 by the American College of Surgeons)
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收藏
页码:635 / 642
页数:8
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