title: Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. david.krpata@uhhospitals.org
authors.forename: David M
authors.initials: DM
authors.lastname: Krpata
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Schmotzer
authors.forename: Susan
authors.initials: S
authors.lastname: Flocke
authors.forename: Judy
authors.initials: J
authors.lastname: Jin
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Blatnik
authors.forename: Bridget
authors.initials: B
authors.lastname: Ermlich
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D034861:Abdominal Wall / Q000502:physiology* / Q000601:surgery; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000503:physiopathology / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome