title: Prospective evaluation of surgeon physical examination for detection of incisional hernias.
abstract: BACKGROUND
  Surgeon physical examination is often used to monitor for hernia recurrence in clinical and research settings, despite a lack of information on its effectiveness. This study aims to compare surgeon-reviewed CT with surgeon physical examination for the detection of incisional hernia.
  
  
  METHODS
  General surgery patients with an earlier abdominal operation and a recent viewable CT scan of the abdomen and pelvis were enrolled prospectively. Patients with a stoma, fistula, or soft-tissue infection were excluded. Surgeon-reviewed CT was treated as the gold standard. Patients were stratified by body mass index into nonobese (body mass index <30) and obese groups. Testing characteristics and real-world performance, including positive predictive value and negative predictive value, were calculated.
  
  
  RESULTS
  One hundred and eighty-one patients (mean age 54 years, 68% female) were enrolled. Hernia prevalence was 55%. Mean area of hernias was 44.6 cm(2). Surgeon physical examination had a low sensitivity (77%) and negative predictive value (77%). This difference was more pronounced in obese patients, with sensitivity of 73% and negative predictive value 69%.
  
  
  CONCLUSIONS
  Surgeon physical examination is inferior to CT for detection of incisional hernia, and fails to detect approximately 23% of hernias. In obese patients, 31% of hernias are missed by surgeon physical examination. This has important implications for clinical follow-up and design of studies evaluating hernia recurrence, as ascertainment of this result must be reliable and accurate.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN. Electronic address: rebeccah.baucom@vanderbilt.edu.
authors.forename: Rebeccah B
authors.initials: RB
authors.lastname: Baucom
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: William C
authors.initials: WC
authors.lastname: Beck
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Holzman
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sharp
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: William H
authors.initials: WH
authors.lastname: Nealon
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
mesh_terms: D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D046449:Hernia, Abdominal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed