Do patient-reported outcomes reliably screen for radiographic hernia recurrence? External validation of the ventral hernia recurrence inventory.

importanceThe Ventral Hernia Recurrence Inventory (VHRI) was developed to establish a relationship between patient-reported outcomes and hernia recurrence after repair. Positive responses have subsequently been adopted as a screening mechanism for recurrence for patients that are unable to attend follow-up visits.

objectiveWe aimed to externally validate the VHRI compared with recurrences identified on cross-sectional imaging.

designThis is a retrospective analysis of patients that have undergone abdominal hernia repairs between 2014 and 2023 and had completed at least 1 year of follow-up from their index surgery.

settingVentral hernia repairs and corresponding imaging analyses were carried out by surgeons with fellowship training in abdominal wall reconstruction.

participantsPatients included in this cohort were also included in previously published clinical trials and retrospective cohorts with VHRI responses captured within 4 months of cross-sectional imaging. All reviewed images were obtained at least 1 year after the index surgery, up to a maximum of 4 years. MAIN OUTCOMES: The primary outcome was the sensitivity and positive predictive value of the VHRI for detecting imaging-confirmed recurrence.

resultsIn 2236 patients, 577 patients had 604 sets of corresponding VHRI responses and cross-sectional images, yielding 70 imaging recurrences for a rate of 12% (95% CI: 9%–14%). More patients that had recurrences answered “no” to the question “Do you see or feel a bulge?” (41 vs. 29; p < 0.01). Regarding the survey’s ability to screen for imaging recurrence, analysis showed a sensitivity and positive predictive value of 41% and 21% for “Do you see or feel a bulge?”, 28% and 20% for “Do you think your hernia has come back?”, and 43% and 16% for “Do you have any physical symptoms or pain at the site?”. When all three questions were used together—defining recurrence as a “yes” to any question—the sensitivity increased to 66% and the positive predictive value was 14%. CONCLUSION AND RELEVANCE: These findings suggest that the VHRI tool has a relatively low sensitivity and PPV when used as a screening tool for recurrences identified on cross-sectional imaging. Future work should focus on the discordance between patient-reported outcomes and recurrences identified on imaging.