Quality assessment in hernia surgery.

Questionnaires were sent five years postoperatively to all patients between 15 and 80 years old at operation who were treated for inguinal or femoral hernia in 1984 at Motala Hospital. Patients were asked about pain or a lump in the operation area and a clinical examination was offered. Of 137 patients with 142 hernias, 92% answered the questionnaire and 88% came to the examination. Among patients who answered the questionnaire and attended the examination the cumulated recurrence rate was 19%, when recurrence was defined as an indication for reoperation or a bulge in the operation area that appeared or increased during abdominal straining. Predictive values for positive and negative questionnaire answers in relation to hernia recurrence were 69% and 95%, respectively. In 14% of hernia operations a reoperation had been performed or was needed. Testicular atrophy was found in 2.7% of male patients. A questionnaire follow-up may be appropriate for identifying patients with symptomatic recurrencies, but it is inadequate as a single indicator of quality assessment in hernia surgery.