New App Predicts Chronic Pain After Inguinal Hernia Surgery

By Christina Frangou
Surgeons and patients considering hernia surgery can now use a free app that predicts a person’s chance of experiencing chronic pain after inguinal hernia repair, based on the outcomes of nearly 1,700 patients treated over the last five years.The app, the Carolinas Equation of Quality of Life (CeQOL), was officially launched at the 5th International Hernia Congress and is available for free download on smartphones, tablets and desktop computers.

The app will help educate patients about the risks for chronic pain, an issue sometimes glossed over in preoperative discussions between physicians and patients, said B. Todd Heniford, MD, the senior researcher of the team that designed the app and chair of gastrointestinal and minimally invasive surgery at Carolinas Medical Center, in Charlotte, N.C.“This app opens up the discussion about the chance of chronic discomfort following inguinal hernia surgery and gives patients a very specific idea of risk,” said Dr. Heniford. “It’s a tool that sets the stage for what we should strive for with every operation: an objective plan to obtain personal quality-of-life outcomes for post-operation and therapy.”

Between 8% and 40% of patients who undergo inguinal hernia repair have chronic pain after surgery, according to previous studies. And that pain often triggers legal action against physicians and hospital systems. In the United Kingdom, chronic pain following hernia repair is the No. 1 cause of malpractice suits. In the United States, 35% of all malpractice case law that relates to hernia repair is related to chronic pain or discomfort.

Bruce Ramshaw, MD, a hernia surgeon and chief medical officer for the Transformative Care Institute, in Daytona Beach, Fla., said the app marks a change in the way outcomes after medical and surgical care are measured.“This app is great because it’s focused on patient quality of life and outcomes from the patient perspective. That’s the direction we are going as a hernia society.”

The app is based on an algorithm developed by Igor Belyansky, a fellow in laparoscopic surgery at Carolinas Medical Center. Dr. Belyansky and colleagues studied data collected between September 2007 and September 2011 by the International Hernia Mesh Registry, a prospectively collected multicenter database that includes data on patients from 30 sites in Canada, the United States, Europe and Australia.

Patients submit data to the registry, by mail or email, and answer questions regarding quality of life, Carolinas Comfort Scale scores and postoperative complications. Researchers studied 2,146 inguinal hernia patients, after excluding cases where more than 10 tacks were used in the repair. [An earlier study, from the same group, showed that the use of more than 10 tacks increases long-term pain (Ann Surg 2011;254:709-714).]

Dr. Heniford, who is the outgoing president of the American Hernia Society, encouraged surgeons and their patients to use the app. Currently, the app applies only to men, because of a shortage of outcomes data following hernia repair in women. He said CeQOL represents a paradigm shift in which the success of a procedure is judged not only by recurrence rates, which are quite low, but also by patients’ quality of life.

The research team plans to recheck the algorithm and update it as needed as more information on quality of life is collected. Additionally, they are designing trials for patients with a high risk for chronic discomfort after inguinal hernia repair to perform patient-directed care instead of hernia-directed care.