Center for Surgical, Medical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, AL, USA.
Surgery. 2011 Sep;150(3):371-8. doi: 10.1016/j.surg.2011.06.007. Epub 2011 Jul 23.
Little information is available on agreement between patient-reported outcomes and data collected from medical chart abstraction (MCA) for recurring events. Recurring conditions pose a risk of misclassification, especially when events occur relatively close together in time. We examined agreement, predictors of agreement, and relative accuracy of patient survey and MCA for assessment of outcomes of incisional hernia repair (IHR).
Surveys to assess hernia outcomes were mailed to 1,124 living patients who underwent ≥ 1 IHR during 1998-2002 at 16 Veteran's Affairs Medical Center study sites. Patients were asked if they developed a recurrence or an infection at their hernia site. Physician-abstracted data from the medical chart were compared with patient response. Chi-square tests were used to assess significance.
Of 487 (43.3%) individuals responding to the survey, 33 (6.8%) with >1 re-repair during 1998-2002 and 98 (20.5%) with a repair before the 1998-2002 period were excluded from the analysis. Although recurrence rates derived from self-reported data and data abstracted from the medical chart were similar (29.3% and 26.1%, respectively), overall concordance was low. Only 49% (n = 54) of self-reported recurrences were confirmed by data abstracted from the medical chart. In addition, 16 (8.3%) recurrences abstracted from the medical chart were not reported by the patient. Factors associated with discordance were high reported pain intensity (P = .02), poorer general health (P = .03), and poorer perceived repair results (P < .0001).
Multiple recurrences and subsequent operations across the study period complicate the interpretation of both patient response and data abstracted from the medical chart when referring to a hernia repair. Further study on how best to assess treatment outcomes for recurring conditions is warranted.
对于复发事件，患者报告的结果与从医疗图表摘录（MCA）中收集的数据之间的一致性信息有限。复发情况存在分类错误的风险，尤其是当事件在时间上相对接近时。我们检查了切口疝修补术（IHR）结果评估中患者调查和 MCA 的一致性、一致性的预测因素以及相对准确性。
1998-2002 年期间，在 16 个退伍军人事务医疗中心研究点进行了至少 1 次 IHR 的 1124 名存活患者邮寄了评估疝结果的调查问卷。患者被问及他们的疝部位是否复发或感染。将从病历中提取的医生数据与患者的反应进行比较。使用卡方检验评估显著性。
在对调查做出回应的 487 名（43.3%）个体中，有 33 名（6.8%）在 1998-2002 年期间进行了>1 次再修复，98 名（20.5%）在 1998-2002 年之前进行了修复，因此被排除在分析之外。尽管来自自我报告数据和从病历中提取的数据得出的复发率相似（分别为 29.3%和 26.1%），但总体一致性较低。只有 49%（n=54）的自我报告复发得到了从病历中提取的数据的证实。此外，有 16 例（8.3%）从病历中提取的复发未被患者报告。与不一致相关的因素包括较高的报告疼痛强度（P=0.02）、较差的总体健康状况（P=0.03）和较差的修复效果感知（P<0.0001）。
在整个研究期间，多次复发和随后的手术使患者反应和从病历中提取的数据在提及疝修复时的解释变得复杂。进一步研究如何最好地评估复发性疾病的治疗结果是有必要的。
