A Promising Study: Open Ventral Hernia Repair Leads to Decreased Pain Intensity and Pain Interference

A PROMISing Study: Open Ventral Hernia Repair Leads to Decreased Pain Intensity and Pain Interference

BACKGROUND – The Patient-Reported Outcomes Measurement Information System (PROMIS) is a rigorous and reliable tool to measure patient feedback.^1-2 Unlike historical methods that only measure pain intensity and quality, the PROMIS Pain Survey directly assesses the impact of pain on patient behavior and the interference of pain on physical, mental and social activities.³ This study addressed the pre- and post-operative pain in patients undergoing midline hernia repairs.

METHODS – All patients undergoing midline hernia repair by the senior author (G.A.D.) since August 2010 have completed the PROMIS Pain Survey. To provide a legacy control of pain intensity, the patients were also administered the 11-point Comparative Pain Scale. All 57 patients who underwent midline hernia repair between August 2010 and October 2012 with preoperative and postoperative PROMIS data were included in this study.

RESULTS – A statistically significant improvement in both the pain intensity (p=0.015) and pain interference (p=0.016) over an average follow up period of 7.1 months was measured. Improvement did not vary with age, BMI, diabetes, smoking, gender, or previous hernia repair. Critical analysis demonstrates that pain interference with physical, mental and social activities continues to decline with increasing time after surgery (See Figure). Pain-related behavior did not change significantly (p=0.268) although the trend was towards improvement.

CONCLUSIONS – The PROMIS Pain Survey provides a precise and multifaceted tool for evaluation of pain.  This outcomes tool demonstrates in a novel manner the benefit of abdominal wall reconstruction with significant improvements in both pain intensity and pain interference following open midline hernia repair.   The scores have improved with length of time since surgery. Given more time, as interference improves, behavior may follow. While not possible in this single surgeon study, PROMIS may be the ideal tool to compare patient reported outcomes across various types of abdominal wall reconstruction.

Figure. Pain interference and behavior scores over time following open ventral hernia repair. (Dotted red line = threshold for clinically significant change; error bars =standard error of the mean)