R Lewis1, B Forman2, M Preston3, E Heidel4, B Alvoid-Preston2, B Ramshaw2. 1. Department of Surgery, University of Tennessee Knoxville Graduate School of Medicine, 1924 Alcoa Hwy Box U-11, Knoxville, TN, 37920, USA. rlewis1@utmck.edu. 2. CQInsights, Knoxville, TN, USA. 3. University Surgeons Associates, Knoxville, TN, USA. 4. Department of Surgery, University of Tennessee Knoxville Graduate School of Medicine, 1924 Alcoa Hwy Box U-11, Knoxville, TN, 37920, USA.
Abstract
PURPOSE: The use of hernia mesh is a common practice in abdominal wall reconstruction (AWR) operations. The high cost of biologic mesh has raised questions about the value of its use in AWR. Resorbable synthetic mesh may have the potential benefits of biologic mesh, minimizing the need for removal when infected, at a lower cost. METHODS: A hernia program has implemented the principles of clinical quality improvement (CQI) to improve patient outcomes. One process improvement attempt was implemented using a newly available resorbable synthetic scaffold. Long-term follow-up was obtained as a part of the CQI process. RESULTS: A total of 91 patients undergoing AWR were included between 8/11 and 9/15 (49 months). There were 58 female (64%) and 33 male (36%) patients. The average age was 57.2 years (28-80). The average BMI was 34.0 (17.6-53.4). There were 52 patients (57%) with recurrent hernias. Mean hernia defect size was 306.6 cm2 (24-720) and mean mesh size was 471.7 cm2 (112-600). Outcomes included a mean length of stay of 7.5 days (0-49), a recurrence rate of 12% (11/91) and a wound complication rate of 27% (25/91). The recurrence rate decreased to 4.5% (3/66) after several improvements, including adopting a transversus abdominus release (TAR) approach, were implemented. There were no mesh-related complications and no mesh removal (partial or total) was required. The mean follow-up length was 42.4 months (0-102). CONCLUSION: In this group of patients, an attempt at process improvement was implemented using a resorbable synthetic scaffold for AWR. With no mesh-related complications and no mesh removals required, there was an improvement in value due to the decrease in mesh cost and improved outcomes over time. Long-term follow-up demonstrated the durability of the repair.
PURPOSE: The use of hernia mesh is a common practice in abdominal wall reconstruction (AWR) operations. The high cost of biologic mesh has raised questions about the value of its use in AWR. Resorbable synthetic mesh may have the potential benefits of biologic mesh, minimizing the need for removal when infected, at a lower cost. METHODS: A hernia program has implemented the principles of clinical quality improvement (CQI) to improve patient outcomes. One process improvement attempt was implemented using a newly available resorbable synthetic scaffold. Long-term follow-up was obtained as a part of the CQI process. RESULTS: A total of 91 patients undergoing AWR were included between 8/11 and 9/15 (49 months). There were 58 female (64%) and 33 male (36%) patients. The average age was 57.2 years (28-80). The average BMI was 34.0 (17.6-53.4). There were 52 patients (57%) with recurrent hernias. Mean hernia defect size was 306.6 cm2 (24-720) and mean mesh size was 471.7 cm2 (112-600). Outcomes included a mean length of stay of 7.5 days (0-49), a recurrence rate of 12% (11/91) and a wound complication rate of 27% (25/91). The recurrence rate decreased to 4.5% (3/66) after several improvements, including adopting a transversus abdominus release (TAR) approach, were implemented. There were no mesh-related complications and no mesh removal (partial or total) was required. The mean follow-up length was 42.4 months (0-102). CONCLUSION: In this group of patients, an attempt at process improvement was implemented using a resorbable synthetic scaffold for AWR. With no mesh-related complications and no mesh removals required, there was an improvement in value due to the decrease in mesh cost and improved outcomes over time. Long-term follow-up demonstrated the durability of the repair.
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