Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands.
J Surg Res. 2020 Jan;245:656-662. doi: 10.1016/j.jss.2019.07.030. Epub 2019 Oct 1.
Incisional hernia (IH) is one of the most frequent complications after abdominal surgery. Follow-up with regard to IH remains challenging. Physical examination and imaging to diagnose IH are time-consuming and costly, require devotion of both the physician and patient, and are often not prioritized. Therefore, a patient-reported diagnostic questionnaire for the diagnosis of IH was developed. Objective of this study was to validate this questionnaire in a consecutive sample of patients.
All patients above 18 y of age who underwent abdominal surgery with a midline incision at least 12 mo ago were eligible for inclusion. Included patients visited the outpatient clinic where they filled out the diagnostic questionnaire and underwent physical examination. The questionnaire answers were compared with the physical examination results. The diagnostic accuracy of the entire questionnaire was assessed by multivariable logistic regression.
In total, 241 patients visited the outpatient clinic prospectively. 54 (22%) patients were diagnosed with IH during physical examination. The area under the receiver operating characteristic curve of the diagnostic questionnaire was 0.82. Sensitivity and specificity were respectively 81.5% and 77.5%. The positive and negative predictive values were 51.2% and 94%, respectively. Ten (19%) patients with IH were missed by the questionnaire.
The patient-reported diagnostic questionnaire as currently proposed cannot be used to diagnose IH. However, given the high negative predictive value, the questionnaire might be used to rule out an IH. Long-term follow-up for the diagnosis of IH should be performed by clinical examination.
切口疝（IH）是腹部手术后最常见的并发症之一。IH 的随访仍然具有挑战性。物理检查和影像学检查来诊断 IH 既耗时又昂贵，需要医生和患者共同投入，而且往往不被优先考虑。因此，开发了一种用于诊断 IH 的患者报告诊断问卷。本研究的目的是在连续的患者样本中验证该问卷。
所有年龄在 18 岁以上、至少 12 个月前接受过中线切口腹部手术的患者均有资格入选。入选患者到门诊就诊，填写诊断问卷并进行体格检查。将问卷答案与体格检查结果进行比较。通过多变量逻辑回归评估整个问卷的诊断准确性。
共有 241 名患者前瞻性地到门诊就诊。54 名（22%）患者在体格检查中被诊断为 IH。诊断问卷的受试者工作特征曲线下面积为 0.82。敏感性和特异性分别为 81.5%和 77.5%。阳性和阴性预测值分别为 51.2%和 94%。10 名（19%）IH 患者被问卷遗漏。
目前提出的患者报告诊断问卷不能用于诊断 IH。然而，鉴于其较高的阴性预测值，该问卷可用于排除 IH。应通过临床检查对 IH 进行长期随访诊断。
