J. Horwitz1, F. Burbano1, R. Lingnurkar2, C. M. Divino1 1Icahn School Of Medicine At Mount Sinai,Department Of Surgery,New York, NEW YORK, USA 2Central Michigan University College Of Medicine,Mount Pleasant, MICHIGAN, USA
Introduction: Patient-reported quality-of-life (QOL) data is becoming an important component of modern surgical quality improvement initiatives. Using the Carolinas Comfort Scale (CCS), a validated QOL survey specific to patients undergoing hernia repairs with mesh, the aim of our study was to prospectively compare QOL outcomes for patients undergoing both laparoscopic and open inguinal hernia repairs.
Methods: Patients undergoing inguinal hernia repairs by a four surgeon group at The Mount Sinai Hospital from 2015-2016 were identified prospectively. The CCS survey was administered at the pre-operative visit, post-operative visit (<1 month from surgery), and follow-up visit (>1 month from surgery). These patients were stratified into operation specific groups: unilateral laparoscopic, bilateral laparoscopic, open with mesh plug-and-patch, open with mesh patch only. The primary outcomes were the CCS survey’s 1-5 point scale for mesh sensation, pain, and movement limitation in the pre-operative, post-operative, and follow-up settings. Secondary outcomes analyzed were blood loss, operative time, admission, re-admission, and recurrence.
Results: 92 patients, at this time, have completed the CCS surveys at all three visits. Mean follow-up time was 4.4 months. Within this group, 40 underwent laparoscopic repairs (31 bilateral and 9 unilateral) and 52 underwent open repairs (35 plug-and-patch, 17 patch only). Each operative group experienced a significant decrease in pain between the pre-operative and follow-up setting. There were no significant QOL differences between the laparoscopic and open groups, nor were QOL differences observed between the unilateral and bilateral laparoscopic groups. The open plug-and-patch group had a significantly higher pain and movement limitation score at follow-up compared to the open patch only group (p = 0.016 and p = 0.031, respectively); of note, no differences were observed at the baseline pre-operative visit. The unilateral laparoscopic group’s operative time was significantly longer than the unilateral open group, 74 vs 59 minutes (p < 0.001). There were no recurrences during the follow-up period.
Conclusion: Using prospective, patient-reported, QOL data with the CCS survey, we have demonstrated that all patients experienced lower pain scores after inguinal hernia repairs, regardless of operation type. There we no QOL differences between laparoscopic or open repairs; however, the open plug-and-patch repair group did experience increased pain and movement limitation at follow-up as compared to the open patch only repair group.