Patient Satisfaction, Chronic Pain, and Functional Status following Laparoscopic Ventral Hernia Repair
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Patient Satisfaction, Chronic Pain, and Functional Status following Laparoscopic Ventral Hernia Repair Mike K. Liang • Marissa Clapp • Linda T. Li Rachel L. Berger • Stephanie C. Hicks • Samir Awad
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Published online: 5 December 2012 Ó Socie´te´ Internationale de Chirurgie 2012
Abstract Background Ventral hernia repairs are one of the most common surgeries performed. Symptoms are the most common motivation for repair. Unfortunately, outcomes of repair are typically measured in recurrence and infection rather than patient focused results. We correlated factors associated with decreased patient satisfaction, chronic pain, and diminished functional status following laparoscopic ventral hernia repair (LVHR) Methods A retrospective study of 201 patients from two affiliated institutions was performed. Patient satisfaction, chronic abdominal pain, pain scores, and Activities Assessment Scale results were obtained in 122 patients. Results were compared with univariate and multivariate analysis. Results Thirty-two (25.4 %) patients were dissatisfied with their LVHR while 21 (17.2 %) patients had chronic abdominal pain and 32 (26.2 %) patients had poor functional status following LVHR. Decreased patient satisfaction was associated with perception of poor cosmetic outcome (OR 17.3), eventration (OR 10.2), and chronic pain (OR 1.4). Chronic abdominal pain following LVHR was associated with incisional hernia (OR 9.0), recurrence (OR 4.3), eventration (OR 6.0), mesh type (OR 1.9), or ethnicity (OR 0.10). Decreased functional status with LVHR was associated with mesh type used (OR 3.7), M. K. Liang (&) M. Clapp L. T. Li R. L. Berger S. Awad Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, OCL (112), Houston, TX 77030, USA e-mail: [email protected] S. C. Hicks Department of Statistics, Rice University, P.O. Box 1892, Houston, TX 77251-1892, USA
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alcohol abuse (OR 3.4), chronic abdominal pain (OR 1.3), and age (OR 1.1). Conclusions One-fourth of patients have poor quality outcome following LVHR. These outcomes are affected by perception of cosmesis, eventration, chronic pain, hernia type, recurrence, mesh type, and patient characteristics/ co-morbidities. Closing central defects and judicious mesh selection may improve patient satisfaction and function. Focus on patient-centered outcomes is warranted.
Introduction Ventral hernia repairs are one of the most common procedures performed by general surgeons [1]. The main motivation for hernia repair revolves around symptoms such as pain, discomfort, and decreased ability to function normally [2–5]. While risk of incarceration and strangulation is also a concern, the likelihood of these complications is modest in comparison to physical symptoms [2–5]. For other types of hernias (such as inguinal or hiatal hernias), symptoms are the main reason for repair, and patients with few or no symptoms can consider conservative treatment or watchful waiting [6]. Despite the fact that quality of life is the main
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