title: 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.affiliation: Halifax Medical Center, Daytona Beach, Florida.
authors.forename: Bradley
authors.initials: B
authors.lastname: Stephan
authors.affiliation: Advanced Hernia Solutions / Surgical Momentum / General Surgery Residency Program, Halifax Medical Center / Florida State University Daytona Beach, Florida.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ramshaw
authors.affiliation: Patient Care Management, Advanced Hernia Solutions, Daytona Beach, Florida.
authors.forename: Brandie
authors.initials: B
authors.lastname: Forman
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D006801:Humans; D019990:Perioperative Care; D058996:Quality Improvement; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D013526:Surgical Mesh; D058106:Wound Closure Techniques