Prospective Cohort Study of the Carolinas Equation for Quality of Life in Multiple Languages Amongst the Asian Population After Inguinal Hernia Surgery

Abstract Introduction Despite the ubiquity of inguinal hernia repair, evidence remains sparse about the validity of tools that assess post-repair Quality of Life (QoL) outcomes in Asian populations. This prospective observational study assessed the QoL outcomes post-surgical repair via the Carolinas Comfort Scale (CCS) to validate translated versions in the multi-lingual Singaporean population. Methods Patients undergoing elective inguinal hernia repair surgery were enrolled in this study from the National University Hospital (n = 156). Clinical data was extracted from electronic records. QoL was assessed using CCS administered at 4 time-points: pre-operatively (baseline), and post-operatively short-term (1 day–POD1), mid-term (3 months–POD3M) and long-term (1 year–POD1Y), available in English, Mandarin and Malay. Results and Discussion Median age and BMI of this cohort were 65 years and 23.39 kg/m2 respectively with a preponderance of males (92.9%), laparoscopic surgery (91.6%) and bilateral operations (65.6%). Post-surgery, while the mean scores for sensation of mesh, pain and movement limitation all decreased with time, only the reduction in pain scores between baseline and POD1 was statistically significant. ASA status was determined to be a significant risk factor for all 3 aspects at POD3M whilst age, race, BMI, ASA status, previous abdominal surgery, laterality of operation, smoking history and surgical approach did not significantly affect the QoL outcomes at baseline and POD1. However, smoking history and laterality of operation significantly affected scores at POD1Y. Conclusion QoL in terms of pain significantly improved in the immediate post operative period. Risk factors for poorer long-term QoL outcomes included worse ASA status, smoking history and unilateral operations.