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- Fränneby, Ulf, et al.
(författare)
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Self-reported adverse events after groin hernia repair, a study based on a national register.
- 2008
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Ingår i: Value in Health. - : Wiley. - 1098-3015 .- 1524-4733. ; 11:5, s. 927-932
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In most clinics, follow-up after inguinal hernia surgery is not a routine procedure and complications may pass unnoticed, thus impairing quality assessment. The aim of this study was to investigate the frequency, spectrum, and risk factors of short-term adverse events after groin hernia repair. METHODS: All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire asking about complications within the first 30 postoperative days. RESULTS: Of the 1643 recorded patients, 1448 (88.1%) responded: 1341 (92.6%) were men and 107 (7.4%) women, mean age 59 years. There were 195 (11.9%) nonresponders. Postoperative complications reported in the questionnaire were hematoma in 203 (14.0%) patients, severe pain in 168 (11.6%), testicular pain in 120 (8.3%), and infection in 105 (7.3%). Adverse events were reported in the questionnaire by 391 (23.8%) patients, whereas only 85 (5.2%) were affected according to the SHR. Risk factors for postoperative complications were age below the median (59 years) among the studied hernia patients (OR 1.36; 95% CI 1.06-1.74) and laparoscopic repair (OR 2.66; 95% CI 1.17-6.05). CONCLUSION: Questionnaires provide valuable additional information concerning postoperative complications. We recommend that they become an integrated part of routine postoperative assessment.
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- Fränneby, Ulf, et al.
(författare)
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Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair.
- 2008
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Ingår i: British Journal of Surgery. - : Wiley. - 0007-1323 .- 1365-2168. ; 95:4, s. 488-493
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Long-term pain is an important outcome after inguinal hernia repair. The aim of this study was to test the validity and reliability of a specific Inguinal Pain Questionnaire (IPQ). METHODS: The study recruited patients aged between 15 and 85 years who had undergone primary inguinal or femoral hernia repair. To test the validity of the questionnaire, 100 patients received the IPQ and the Brief Pain Inventory (BPI) 1 and 4 weeks after surgery (group 1). To test reliability and internal consistency, 100 patients received the IPQ on two occasions 1 month apart, 3 years after surgery (group 2). Non-surgery-related pain was analysed in group 3 (2853 patients). RESULTS: A significant decrease in IPQ-rated pain intensity was observed in the first 4 weeks after surgery (P < 0.001). Significant correlations with corresponding BPI pain intensity items corroborated the criterion validity (P < 0.050). Logical incoherence did not exceed 5.5 per cent for any item. Values for kappa in the test-retest in group 2 were higher than 0.5 for all but three items. Cronbach's alpha was 0.83 for questions on pain intensity and 0.74 for interference with daily activities. CONCLUSION: This study found good validity and reliability for the IPQ, making it a useful instrument for assessing pain following groin hernia repair.
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- Olsson, Anders, et al.
(författare)
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Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair
- 2017
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Ingår i: Surgery. - : Elsevier. - 0039-6060 .- 1532-7361. ; 161:2, s. 509-516
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic pain is common after inguinal hernia repair and has become one of the most important outcome measures for this procedure. The purpose of this study was to determine whether or not there is a relationship between specific postoperative complications and risk for chronic pain after open inguinal hernia repair.METHODS: A prospective cohort study was designed in which participants responded to the Inguinal Pain Questionnaire regarding postoperative groin pain 8 years after inguinal hernia repair. Responses to the questionnaire were matched with data from a previous study regarding reported postoperative complications after open inguinal hernia repair. Participants were recruited originally from the Swedish Hernia Register. Response rate was 82.4% (952/1,155). The primary outcome was chronic pain in the operated groin at follow-up. Grading of pain was performed using the Inguinal Pain Questionnaire.RESULTS: A total of 170 patients (17.9%) reported groin pain and 29 patients (3.0%) reported severe groin pain. The risk for developing chronic groin pain was greater in patients with severe pain in the preoperative or immediate postoperative period (odds ratio 2.09; 95% confidence interval 1.28-3.41). Risk for chronic pain decreased for every 1-year increase in age at the time of operation (odds ratio 0.99, 95% confidence interval 0.98-1.00).CONCLUSION: Both preoperative pain and pain in the immediate postoperative period are strong risk factors for chronic groin pain. Risk factor patterns should be considered before operative repair of presumed symptomatic inguinal hernias. The problem of postoperative pain must be addressed regarding both pre-emptive and postoperative analgesia.
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- Olsson, Anders, et al.
(författare)
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The Short-Form Inguinal Pain Questionnaire (sf-IPQ) : An Instrument for Rating Groin Pain After Inguinal Hernia Surgery in Daily Clinical Practice
- 2019
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 43:3, s. 806-811
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Inguinal Pain Questionnaire (IPQ) is a standardised and validated instrument for assessing persisting pain after groin hernia surgery. The IPQ is often perceived as being too extensive for routine use. The aim of this study was to develop and evaluate a condensed version of the IPQ in order to facilitate its use in daily clinical practice.Methods: The condensed form, i.e. Short-Form Inguinal Pain Questionnaire (sf-IPQ), comprises two main items taken from the IPQ. Four hundred patients were recruited from the Swedish Hernia Register and were sent the IPQ, sf-IPQ and the Short-Form McGill Pain Questionnaire (SF-MPQ) three years after hernia repair. Ratings from the IPQ and the sf-IPQ were converted to a 12-point scale. The reported scores for the two shared items in the IPQ and sf-IPQ were compared using the Intraclass Correlation Coefficient (ICC), Cohen’s kappa and McNemar’s test.Results: After two reminders, the response rate was 69.8% (n = 279/400). The ICC for the IPQ and sf-IPQ scores was 0.78 (95% confidence interval 0.73–0.82, p < 0.001). Cohen’s kappa was 0.66 (95% confidence interval 0.55–0.77, p < 0.001). The sf-IPQ systematically indicated a higher pain score than the IPQ (p = 0.013).Conclusions: Despite the systematic difference in level of pain scored, correlation, consistency and agreement were seen between the IPQ and sf-IPQ. The forms appear to be interchangeable, though the sf-IPQ may be a more sensitive instrument. The condensed structure of the sf-IPQ is more user-friendly and shows promise as a useful tool in daily clinical practice.
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| 7. |
- Wefer, Agnes, et al.
(författare)
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Patient-reported adverse events after hernia surgery and socio-economic status : A register-based cohort study
- 2016
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Ingår i: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9191 .- 1743-9159. ; 35, s. 100-103
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the present study was to assess how socio-economic background influences perception of an adverse postoperative event after hernia surgery, and to see if this affects the pattern of seeking healthcare advice during the early postoperative period.MATERIALS AND METHODS: All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire inquiring about adverse events. Data on civil status, income, level of education and ethnic background were obtained from Statistics Sweden.RESULTS: Of the 1643 patients contacted, 1440 (87.6%) responded: 1333 (92.6%) were men and 107 (7.4%) women, mean age was 59 years. There were 203 (12.4%) non-responders. Adverse events were reported in the questionnaire by 390 (27.1%) patients. Patients born in Sweden and patients with high income levels reported a significantly higher incidence of perceived adverse events (p < 0.05). Patients born in Sweden and females reported more events requiring healthcare contact. There was no association between registered and self-reported outcome and civil status or level of education.CONCLUSION: We detected inequalities related to income level, gender and ethnic background. Even if healthcare utilization is influenced by socio-economic background, careful information of what may be expected in the postoperative period and how adverse events should be managed could lead to reduced disparity and improved quality of care in the community at large.
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| 8. |
- Fränneby, Ulf
(författare)
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Patient-orientated aspects of the postoperative course after hernia surgery
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Operations for inguinal hernia are one of the most common surgical procedures performed. With the development of mesh techniques, recurrence rates have improved radically and patient-orientated endpoints have evolved as important outcome measures. In recent studies, 15-50% of patients may experience some form of pain years after repair. One reason for the diverging results is the lack of a uniform assessment of postoperative pain. Pain is not defined, nor is it measured in the same way in the different studies. Moreover, postoperative complications are infrequently recorded in everyday surgical practice and many hospitals lack a continuous structured follow-up, making reliable quality assurance assessments difficult. As quality assurance protocols are often retrospective studies rather than prospective, they will have to rely on questionnaires to be answered by the patient to get an estimate of postoperative pain and adverse events. In order to improve the performance in hernia surgery, the National Hernia Register (NHR) was started in Sweden in 1992 and today more than 90% of all inguinal and femoral hernia operations in patients 15 years and older are prospectively recorded. Information on age, gender, type of hernia as noted during the operation and type of repair as well as observed complications are recorded. Patients are entered in the register by their unique National Identification Number and can thus be traced in the register for subsequent operations regardless of the unit performing the operation as well as in other national registers. As of today more than 120 000 operations are gathered in the register. In the following papers, making the basis of this thesis, we have studied the following issues: Paper I is a study on the discordance between the patient's and the surgeon's perception of complications. Some 206 patients having surgery for inguinal hernia were invited to a follow-up 3-6 weeks after the operation. The patient was asked to fill in a questionnaire with 12 questions concerning postoperative complications prior to the visit. The examining surgeon who had not participated in the operation and was blinded to the patient's questionnaire filled in a similar protocol. The concordance between the surgeon and the patient in assessing complications was poor and reflects their different understanding of "adverse events", the surgeon assessing technical complications and the patient the symptoms. Paper II is based on a questionnaire study of postoperative adverse events submitted to 1643 patients recorded in the hernia register during 2 consecutive months in 2002. The response rate was 88% (1448 patients). The most common complications recorded were haematoma in 203 (14%) patients, severe pain in 168 (12%) patients, testicular pain in 120 (8%) patients and infection in 105 (7%) patients. The risk-factors for complications were age below the median of 59 years and laparoscopic repair. The National Hernia Register covered 25% of the complications recorded by the patients in the questionnaire, reflecting that a passive recording of complications, i.e. the clinic only record what comes to their knowledge, is less accurate than a structured follow-up. The study showed that a structured follow-up may improve quality control of surgery, since only a small number of the adverse events perceived by the patient come to the knowledge of the healthcare provider. Paper III introduces the novel Inguinal Pain Questionnaire (IPQ) which is the first assessment instrument specifically designed for evaluation of pain after hernia surgery. The questionnaire consists of 18 items and is divided in a pain intensity section using a 7-step behavioural rating scale and a section for interference with daily activities with a dichotomous scale. The aim of this study is to test its validity and reliability. The validity is tested in 100 patients filling in the IPQ and Brief Pain Inventory 1 and 4 weeks after the operation for a unilateral groin hernia. Reliability and internal consistency was tested in another 100 patients filling in the IPQ 3 years after the operation on 2 occasions one month apart. Non-surgery related pain was analysed in a cohort of 2853 patients derived from the NHR, and they were sent the IPQ by regular mail 2-3 years after the operation. Non-surgery related pain was assessed by comparing pain in the groin having surgery to the side that did not. In conclusion the validity, reliability and internal consistency were acceptable. The non-surgery related pain did not exceed 5.5% for any item. Paper IV is a study on long-term pain after hernia surgery. From the NHR 2853 patients having surgery for a unilateral groin hernia were sent the IPQ 2-3 years after the operation by regular mail with 2456 patients (86%) responding. In response to the question "worst pain past week" 758 patients (31%) reported some pain and 144 patients (6%) reported pain that interfered with daily activities. Age below median, a high level of preoperative pain, techniques involving an anterior approach and the occurrence of any postoperative complication were found to predict long-term pain. In conclusion, quality assurance in groin hernia surgery can be facilitated by the use of local or national registers together with a structured follow-up in order to identify risk-factors and encourage a high standard of care.
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