A Patient-Centered Appraisal of Outcomes Following Abdominal Wall Reconstruction: A Systematic Review of the Current Literature

Introduction

The importance of patient centered outcomes including quality of life measures, functional outcomes, pain assessment, and overall satisfaction scores have become important variables to consider following ventral hernia repair.  Published outcomes often focus on recurrence and immediate postoperative complications. ^1-3  While important, these are incomplete endpoints of surgical success.  Published assessment tools have attempted to investigate these outcome measures; however, quality of life following hernia repair remains unclear.  The goal of this study was to determine the effect of having a ventral hernia on quality of life measures and whether treatment ameliorated these deleterious effects.  To this end, a systematic review of the current literature was conducted to integrate the available data on quality of life, pain assessment, functionality, and overall satisfaction following ventral hernia repair. 

Methods

MEDLINE Pubmed and Cochrane databases were searched, and 880 articles were identified. After limits were applied, 35 articles were retrieved for evaluation.  Of these, 28 articles were accepted for this review.   Analysis included assessment tools that were utilized in obtaining HRQoL measures including quality of life, pain, physical function, overall satisfaction with surgery, impact of different surgical techniques, and influence on social functioning.

Results

Of the 28 included studies, 27.6% (8/28) were randomized prospective trials, 41.4% (11/28) were nonrandomized prospective cohort studies, and 31% (9/28) were nonrandomized retrospective cohort studies.  Mean study size was 134.5 subjects, and mean hernia defect size was 71.6cm².  Overall HRQoL was assessed in 78.6% (22/28) of studies, pain was formally assessed in 71.4% (20/28) of studies, 67.9% (19/28) of studies assessed functionality, and 35.7% (10/28) of studies surveyed overall satisfaction after ventral hernia repair.  The SF-36 was utilized in 59.1% (13/22) of the included studies.  The VAS pain assessment tool was utilized in 60% (12/20) of the studies evaluating pain.

Discussion

Patients with a ventral hernia are more likely to report a lower HRQoL than the general population.  Ventral hernia repair is correlated with improved quality of life measures including improved physical function, decreased pain, and overall satisfaction after surgery.  There is lack of evidence to support laparoscopic versus open hernia repair as a superior method in improving patient-centered outcomes.