Low long-term decision regret following mesh-based hernia repair: 5-year outcomes in a previously surveyed cohort.

BACKGROUND

Preoperative concerns about mesh are common, but their relationship to long-term decision regret after hernia repair (HR) remains unclear. We evaluated long-term decision regret (DR) among patients who previously completed a preoperative mesh perception survey followed by mesh-based hernia repair.

METHODS

Patients who had previously completed a preoperative mesh perception survey and later underwent HR were surveyed to assess DR using the Brehaut Decision Regret Scale (BDRS). The BDRS ranges from 0 (no regret) to 100 (highest regret). Scores ≤ 25 were considered minimal regret, while scores > 25 indicated more than minimal regret. Descriptive analyses were performed.

RESULTS

Of 202 patients in the original survey cohort, 97 (48.0%) underwent HR, and 48 (49.5%) completed the follow-up BDRS survey. Mean age was 58.9 ± 12.8 years, 64.6% were male, and 29.2% had history of recurrent hernia. The average time since surgery to survey was 60.2 ± 18.8 months. Overall, mean BDRS was 9.9 ± 14.5, and 95.9% agreed that surgery was the right decision, with 85.4% reporting minimal regret and 52.1% reporting no regret. Ventral hernias comprised 47.9% of cases and had the lowest mean regret (3.9 ± 6.6), with no patients scoring > 25. Inguinal (31.3%) and umbilical (8.3%) hernias had higher mean scores (16.7 ± 17.2 and 23.8 ± 18.9, respectively). Among the 7 (14%) patients with scores > 25, all were primary hernias, and most reported postoperative discomfort or minor wound complications. Correlation analyses comparing preoperative survey with postoperative BDRS scores found very early expectation of recovery and graduate-level education were associated with higher regret scores.

CONCLUSION

Long-term DR following mesh-based HR is uncommon, with most patients reporting minimal or no regret an average of 5 years postoperatively. Ventral hernia repair had the lowest DR, while inguinal and umbilical repair had higher scores. These findings suggest that mesh-based hernia repair is associated with favorable long-term, patient-reported decision satisfaction.