[The success of hernia surgery in routine care from the patient's perspective].
BACKGROUND
The study was conducted in cooperation with a German sickness fund (Gmünder Ersatzkasse GEK) to determine the success of surgery for inguinal hernia from the patient's perspective.


METHODS
We developed a standardized questionnaire containing, among other things, pre- and postoperative subjective assessment of disease-specific symptoms, complications, and health-related quality of life (SF-36). All beneficiaries (age 35-75 years), who were treated in the hospital for inguinal hernia repair (ICD-550) between November 1996 and January 1997 (n = 502) were sent the questionnaire at an average of 3 months (T1) and 14 months postoperatively. The response rate at T1 was 73%. At T2 data from 280 patients were available for analysis: 96% were male (mean age: 54 years). Descriptive and multivariate analysis (GSK model) were performed to reveal determinants of disease-specific symptom alleviation and health-related quality of life.


RESULTS
Postoperative hematoma and genital swelling were reported by a quarter of the respondents, each. Pyogenic wound infection appeared in 4%. Compared to the (recalled) preoperative symptom level at T1 substantial and statistical significant improvements were apparent (P < 0.0001). These were maintained at T2 (disease-specific symptom checklist: preoperative: 10.7; T1: 2.8; T2: 2.5). Health-related quality of life reached the level of the German reference population in three of the eight subscales of the SF-36 at T1, and in five SF-36 subscales at T2. However, at T2 (still existing) deviations from the reference population in three of the SF-36 subscales were small. Bi- and multivariate analysis reveals that the appearance of complications from the patient's perspective has to be considered the main determinant of disease-specific symptom alleviation and health-related quality of life after hernia repair.


CONCLUSIONS
Inguinal hernia repair leads to substantial improvements in disease-specific symptoms. Overall, health-related quality of life reaches the level of the reference population. The patient's perception of complications is the major determinant of health outcomes.
Bitzer
E M
EM
Institut für Sozialmedizin, Epidemiologie und Gesundheitssystemforschung, Hannover. bitzer@iseg.org
Dörning
H
H
Schwartz
F W
FW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires