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

IMPORTANCE: The 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. OBJECTIVE: We aimed to externally validate the VHRI compared with recurrences identified on cross-sectional imaging. DESIGN: This 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. SETTING: Ventral hernia repairs and corresponding imaging analyses were carried out by surgeons with fellowship training in abdominal wall reconstruction. PARTICIPANTS: Patients 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. RESULTS: In 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.