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

Surg Technol Int. 2015 May;26:135-42.

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.

MeSH terms

  • Abdominal Wall / surgery*
  • Follow-Up Studies
  • Hernia, Ventral / surgery*
  • Herniorrhaphy / instrumentation
  • Herniorrhaphy / methods
  • Herniorrhaphy / standards*
  • Humans
  • Perioperative Care
  • Quality Improvement
  • Reconstructive Surgical Procedures / instrumentation
  • Reconstructive Surgical Procedures / methods
  • Reconstructive Surgical Procedures / standards*
  • Surgical Mesh
  • Wound Closure Techniques