Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction.

Abstract

Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program. After over 60 cases, improvement in materials costs and postoperative outcomes were documented. No mesh-related complications occurred and no mesh removal was required. In this real-world, value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved health care value globally.

• Authors: Bradley Stephan, Bruce Ramshaw, Brandie Forman
• Journal: Surgical technology international (Surg Technol Int) Vol. 26 Pg. 135-42 (May 2015) ISSN: 1090-3941 [Print] United States
• PMID: 26055001 (Publication Type: Journal Article)

Topics

• Abdominal Wall (surgery)
• Follow-Up Studies
• Hernia, Ventral (surgery)
• Herniorrhaphy (instrumentation, methods, standards)
• Humans
• Perioperative Care
• Quality Improvement
• Plastic Surgery Procedures (instrumentation, methods, standards)
• Surgical Mesh
• Wound Closure Techniques