Cherla Deepa V, Moses Maya L, Viso Cristina P, Holihan Julie L, Flores-Gonzalez Juan R, Kao Lillian S, Ko Tien C, Liang Mike K
Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX, USA.
World J Surg. 2018 Jan;42(1):19-25. doi: 10.1007/s00268-017-4173-6.
The modified Activities Assessment Scale (AAS) is a 13-question abdominal wall quality of life (AW-QOL) survey validated in patients undergoing ventral hernia repair (VHR). No studies have assessed AW-QOL among individuals without abdominal wall pathology. The minimal clinically important difference (MCID) of the modified AAS and its implications for the threshold at which VHR should be offered also remain unknown. Our objectives were to (1) establish the AW-QOL of patients with a clinical abdominal wall hernia versus those with no hernia, (2) determine the MCID of the modified AAS, and (3) identify the baseline quality of life (QOL) score at which patients derive little clinical benefit from VHR.
Patient-centered outcomes data for all patients presenting to General Surgery and Hernia Clinics October-December 2016 at a single safety-net institution were collected via a prospective, cross-sectional observational study design. Primary outcome was QOL measured using the modified AAS. Secondary outcome was the MCID.
Patients with no hernia had modified AAS scores of 81.6 (50.4-94.4), while patients with a clinically apparent hernia had lower modified AAS scores of 31.4 (12.6-58.7) (p < 0.001). The MCID threshold was 7.6 for a "slight" change and 14.9 for "definite" change. Above a modified AAS score of 81, the risk of worsening a patient's QOL by surgery is higher than the chances of improvement.
VHR can improve 1-year postsurgical AW-QOL to levels similar to that of the general population. The MCID of the modified AAS is 7.6 points. Patients with high baseline scores should be counseled about the lack of potential benefit in QOL from elective VHR.
改良活动评估量表（AAS）是一项包含13个问题的腹壁生活质量（AW-QOL）调查问卷，已在接受腹疝修补术（VHR）的患者中得到验证。尚无研究评估无腹壁病变个体的AW-QOL。改良AAS的最小临床重要差异（MCID）及其对VHR手术阈值的影响也尚不清楚。我们的目标是：（1）确定临床腹壁疝患者与无疝患者的AW-QOL；（2）确定改良AAS的MCID；（3）确定患者从VHR中获得临床益处不大的基线生活质量（QOL）评分。
通过前瞻性横断面观察性研究设计，收集了2016年10月至12月在一家单一安全网机构的普通外科和疝诊所就诊的所有患者的以患者为中心的结局数据。主要结局是使用改良AAS测量的QOL。次要结局是MCID。
无疝患者的改良AAS评分为81.6（50.4-94.4），而有明显临床疝的患者改良AAS评分较低，为31.4（12.6-58.7）（p<0.001）。“轻微”变化的MCID阈值为7.6，“明确”变化的MCID阈值为14.9。改良AAS评分高于81时，手术使患者QOL恶化的风险高于改善的机会。
VHR可将术后1年的AW-QOL提高到与普通人群相似的水平。改良AAS的MCID为7.6分。对于基线评分高的患者，应告知其择期VHR在QOL方面缺乏潜在益处。
