Design and initial implementation of HerQLes: A hernia-related quality-of-life survey to assess abdominal wall function

David M. Krpata, Brian J. Schmotzer, Susan Flocke, Judy Jin, Jeffrey A. Blatnik, Bridget Ermlich, Yuri W. Novitsky, Michael J. Rosen

Research output: Contribution to journalArticlepeer-review

172 Scopus citations


Background: Success of a surgical intervention is often measured by hard clinical outcomes. In ventral hernia repair (VHR) these include wound morbidity and hernia recurrence. These outcomes fail to account for a surgical intervention's effect on a patient's quality of life (QofL). Our objective was to design a hernia-specific QofL instrument with a focus on abdominal wall function, evaluate its measurement properties, and assess the impact of VHR on QofL using this new instrument. Study Design: A 16-question QofL survey tool, HerQLes, was constructed. Patients presenting for elective VHR completed the survey. Rasch modeling was used to evaluate the items; fit statistics, person-item mapping, separation index, and reliability were examined. Associations between baseline characteristics and QofL were assessed. Results: Eighty-eight patients completed the survey before assessment for VHR. Mean age was 57.2 years (±12.4 years), mean American Society of Anesthesiologists score was 2.8 (±0.5), and mean body mass index was 34.9 kg/m2 (±9.3 kg/m2). Based on Rasch modeling, 12 of 16 items met model fit criteria. The 4 poorly fitting items were eliminated from further analysis. The 12 items retained have good internal consistency reliability (0.86). On a 0- to 100-point scale, mean QofL score was 47.2 (±15.6). Patients with higher grade hernias had lower HerQLes scores (p = 0.06). Patients showed significant improvement in abdominal wall function and QofL 6 months after VHR (p < 0.01). Conclusions: Quality-of-life is an important component of surgical management of ventral hernias. The 12-question QofL survey, HerQLes, is reliable and valid. At baseline, patients with more complex hernias tended to have a decreased abdominal wall function and QofL. Six months after surgical repair, HerQLes scores change in the predicted direction. We believe HerQLes is potentially a valuable tool to assess patient-centered abdominal wall functional improvements after VHR.

Original languageEnglish (US)
Pages (from-to)635-642
Number of pages8
JournalJournal of the American College of Surgeons
Issue number5
StatePublished - Nov 2012
Externally publishedYes


  • HerQLes
  • Hernia-Related Quality-of-Life Survey
  • QofL
  • SF-36
  • Short Form-36
  • VHR
  • quality of life
  • ventral hernia repair

ASJC Scopus subject areas

  • Medicine(all)


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