A clinician's guide to patient selection for watchful waiting management of inguinal hernia

George A. Sarosi, Yongliang Wei, James O. Gibbs, Domenic J. Reda, Martin McCarthy, Robert Joseph Fitzgibbons, Jeffrey S T Barkun

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: The goal of this study was to assist surgeons in managing patients with minimally symptomatic inguinal hernia by identifying characteristics that predict crossover to surgery or worsening of hernia symptoms. Background: Randomized trials have suggested that watchful waiting mana-gement of minimally symptomatic inguinal hernia is an acceptable alternative to surgical repair. However, these trials found that roughly a quarter of patients would elect for repair in the first 2 years, suggesting that not all patients are good candidates for watchful waiting. Methods: The 336 patients randomized to watchful waiting in the American College of Surgeons Watchful Waiting Hernia Trial constituted the study popu-lation. Preoperative patient characteristics were used to predict 2 outcomes, either crossover to surgery or the development of hernia pain limiting activities and/or crossover to surgery. Patients in our study were part of a previously registered randomized trial: NCT00263250. Results:: At 2 years, 72 patients crossed over to surgery, with pain with strenuous activities [odds ratio (OR), 1.3 per 10-mm visual analog scale pain scale], chronic constipation (OR, 4.9), prostatism (OR, 2.9), being married (OR, 2.3), and good health [OR, 3.0 American Society of Anesthesiologists Class (ASA) 1 vs 2], predicting crossover. An additional 28 patients developed pain, limiting their activities, with pain during strenuous activities (OR, 1.3 per 10-mm visual analog scale) and chronic constipation (OR, 4.5), predicting the combined outcome of pain limiting activities and/or crossover to surgery. Higher levels of activity reduced the risk (OR, 0.95) of this combined outcome. Conclusions: Readily identifiable patient characteristics can predict those patients with minimally symptomatic inguinal hernia who are likely to "fail" watchful waiting hernia management. Consideration of these factors will allow surgeons to optimally tailor hernia management.

Original languageEnglish
Pages (from-to)605-610
Number of pages6
JournalAnnals of Surgery
Volume253
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Watchful Waiting
Inguinal Hernia
Patient Selection
Odds Ratio
Hernia
Pain
Constipation
Prostatism
Pain Measurement
Visual Analog Scale

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

A clinician's guide to patient selection for watchful waiting management of inguinal hernia. / Sarosi, George A.; Wei, Yongliang; Gibbs, James O.; Reda, Domenic J.; McCarthy, Martin; Fitzgibbons, Robert Joseph; Barkun, Jeffrey S T.

In: Annals of Surgery, Vol. 253, No. 3, 03.2011, p. 605-610.

Research output: Contribution to journalArticle

Sarosi, George A. ; Wei, Yongliang ; Gibbs, James O. ; Reda, Domenic J. ; McCarthy, Martin ; Fitzgibbons, Robert Joseph ; Barkun, Jeffrey S T. / A clinician's guide to patient selection for watchful waiting management of inguinal hernia. In: Annals of Surgery. 2011 ; Vol. 253, No. 3. pp. 605-610.
@article{292361095c14473699d8de43dcd4b518,
title = "A clinician's guide to patient selection for watchful waiting management of inguinal hernia",
abstract = "Objective: The goal of this study was to assist surgeons in managing patients with minimally symptomatic inguinal hernia by identifying characteristics that predict crossover to surgery or worsening of hernia symptoms. Background: Randomized trials have suggested that watchful waiting mana-gement of minimally symptomatic inguinal hernia is an acceptable alternative to surgical repair. However, these trials found that roughly a quarter of patients would elect for repair in the first 2 years, suggesting that not all patients are good candidates for watchful waiting. Methods: The 336 patients randomized to watchful waiting in the American College of Surgeons Watchful Waiting Hernia Trial constituted the study popu-lation. Preoperative patient characteristics were used to predict 2 outcomes, either crossover to surgery or the development of hernia pain limiting activities and/or crossover to surgery. Patients in our study were part of a previously registered randomized trial: NCT00263250. Results:: At 2 years, 72 patients crossed over to surgery, with pain with strenuous activities [odds ratio (OR), 1.3 per 10-mm visual analog scale pain scale], chronic constipation (OR, 4.9), prostatism (OR, 2.9), being married (OR, 2.3), and good health [OR, 3.0 American Society of Anesthesiologists Class (ASA) 1 vs 2], predicting crossover. An additional 28 patients developed pain, limiting their activities, with pain during strenuous activities (OR, 1.3 per 10-mm visual analog scale) and chronic constipation (OR, 4.5), predicting the combined outcome of pain limiting activities and/or crossover to surgery. Higher levels of activity reduced the risk (OR, 0.95) of this combined outcome. Conclusions: Readily identifiable patient characteristics can predict those patients with minimally symptomatic inguinal hernia who are likely to {"}fail{"} watchful waiting hernia management. Consideration of these factors will allow surgeons to optimally tailor hernia management.",
author = "Sarosi, {George A.} and Yongliang Wei and Gibbs, {James O.} and Reda, {Domenic J.} and Martin McCarthy and Fitzgibbons, {Robert Joseph} and Barkun, {Jeffrey S T}",
year = "2011",
month = "3",
doi = "10.1097/SLA.0b013e31820b04e9",
language = "English",
volume = "253",
pages = "605--610",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - A clinician's guide to patient selection for watchful waiting management of inguinal hernia

AU - Sarosi, George A.

AU - Wei, Yongliang

AU - Gibbs, James O.

AU - Reda, Domenic J.

AU - McCarthy, Martin

AU - Fitzgibbons, Robert Joseph

AU - Barkun, Jeffrey S T

PY - 2011/3

Y1 - 2011/3

N2 - Objective: The goal of this study was to assist surgeons in managing patients with minimally symptomatic inguinal hernia by identifying characteristics that predict crossover to surgery or worsening of hernia symptoms. Background: Randomized trials have suggested that watchful waiting mana-gement of minimally symptomatic inguinal hernia is an acceptable alternative to surgical repair. However, these trials found that roughly a quarter of patients would elect for repair in the first 2 years, suggesting that not all patients are good candidates for watchful waiting. Methods: The 336 patients randomized to watchful waiting in the American College of Surgeons Watchful Waiting Hernia Trial constituted the study popu-lation. Preoperative patient characteristics were used to predict 2 outcomes, either crossover to surgery or the development of hernia pain limiting activities and/or crossover to surgery. Patients in our study were part of a previously registered randomized trial: NCT00263250. Results:: At 2 years, 72 patients crossed over to surgery, with pain with strenuous activities [odds ratio (OR), 1.3 per 10-mm visual analog scale pain scale], chronic constipation (OR, 4.9), prostatism (OR, 2.9), being married (OR, 2.3), and good health [OR, 3.0 American Society of Anesthesiologists Class (ASA) 1 vs 2], predicting crossover. An additional 28 patients developed pain, limiting their activities, with pain during strenuous activities (OR, 1.3 per 10-mm visual analog scale) and chronic constipation (OR, 4.5), predicting the combined outcome of pain limiting activities and/or crossover to surgery. Higher levels of activity reduced the risk (OR, 0.95) of this combined outcome. Conclusions: Readily identifiable patient characteristics can predict those patients with minimally symptomatic inguinal hernia who are likely to "fail" watchful waiting hernia management. Consideration of these factors will allow surgeons to optimally tailor hernia management.

AB - Objective: The goal of this study was to assist surgeons in managing patients with minimally symptomatic inguinal hernia by identifying characteristics that predict crossover to surgery or worsening of hernia symptoms. Background: Randomized trials have suggested that watchful waiting mana-gement of minimally symptomatic inguinal hernia is an acceptable alternative to surgical repair. However, these trials found that roughly a quarter of patients would elect for repair in the first 2 years, suggesting that not all patients are good candidates for watchful waiting. Methods: The 336 patients randomized to watchful waiting in the American College of Surgeons Watchful Waiting Hernia Trial constituted the study popu-lation. Preoperative patient characteristics were used to predict 2 outcomes, either crossover to surgery or the development of hernia pain limiting activities and/or crossover to surgery. Patients in our study were part of a previously registered randomized trial: NCT00263250. Results:: At 2 years, 72 patients crossed over to surgery, with pain with strenuous activities [odds ratio (OR), 1.3 per 10-mm visual analog scale pain scale], chronic constipation (OR, 4.9), prostatism (OR, 2.9), being married (OR, 2.3), and good health [OR, 3.0 American Society of Anesthesiologists Class (ASA) 1 vs 2], predicting crossover. An additional 28 patients developed pain, limiting their activities, with pain during strenuous activities (OR, 1.3 per 10-mm visual analog scale) and chronic constipation (OR, 4.5), predicting the combined outcome of pain limiting activities and/or crossover to surgery. Higher levels of activity reduced the risk (OR, 0.95) of this combined outcome. Conclusions: Readily identifiable patient characteristics can predict those patients with minimally symptomatic inguinal hernia who are likely to "fail" watchful waiting hernia management. Consideration of these factors will allow surgeons to optimally tailor hernia management.

UR - http://www.scopus.com/inward/record.url?scp=79951674153&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79951674153&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e31820b04e9

DO - 10.1097/SLA.0b013e31820b04e9

M3 - Article

C2 - 21239979

AN - SCOPUS:79951674153

VL - 253

SP - 605

EP - 610

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -