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Vanderbilt University Medical Center Reporter

New collaborative to gather hernia surgery outcomes data


Benjamin Poulose, M.D., MPH, and colleagues are studying how best to treat ventral abdominal hernias. (photo by John Russell)

Each year, more than 350,000 people in the United States undergo surgery to treat painful ventral abdominal hernias, a condition that affects up to 30 percent of patients who have had any kind of abdominal surgery.

Yet, for such a common procedure, very little medical evidence exists on how to best treat this condition, leading many patients to return to the hospital when their painful hernias come back, and adding millions to the country’s rising health care costs.

To address this issue, Benjamin Poulose, M.D., MPH, assistant professor of Surgery at Vanderbilt University Medical Center, and Michael Rosen, M.D., associate professor of Surgery at University Hospitals Case Medical Center in Cleveland, Ohio, have formed the American Hernia Society Quality Collaborative (AHSQC).

With $250,000 in funding from the American Hernia Society, this quality collaborative will, for the first time, gather actual clinical, operational and outcome data to determine the best patient-centered approaches to ventral hernia repair and recovery.

“If a patient has stage II colon cancer, she can expect to get virtually the same treatment anywhere in the world. But if a patient has an abdominal wall hernia, her treatment can vary significantly between countries, states, hospitals and even within the same practice,” said Poulose. “That’s because the quality and availability of medical evidence on how to best treat these hernias just isn’t there.

“Without adequate federal funding for unbiased research, we simply don’t know what works best. Is a $15,000 mesh device better than a $500 one? We really don’t know. All this leads to suboptimal results, wide and unacceptable variations in patient care, and rampant, unsustainable health care costs. We have to stop the madness,” Poulose said.

In a paper published in Hernia last September, Poulose estimates that by reducing the recurrence of ventral hernias by just 1 percent, the U.S. health care system could save $32 million in operation costs alone. These savings don’t even factor in time away from work and disability for each patient.

In the initial phase of the collaborative, Vanderbilt is coordinating the creation of 20 pilot sites throughout the country. Surgeons and health care providers from these sites will provide critical feedback on what kind of data needs to be collected and how it will be analyzed.

Using a cloud-based registry, the quality collaborative will be able to provide surgeons the world over with real-time results on risk, reliability and long-term benefits of surgical procedures and treatments by analyzing surgical outcome data.

These data can then be used to create individual treatment plans that take each patient’s unique factors into consideration, including age, co-morbidities, body mass index and overall size of the hernia.

The ArborMetrix cloud-based registry system was developed by John Birkmeyer, M.D., professor of Surgery at the University of Michigan and director of the Center for Healthcare Outcomes & Policy.

“For the first time, we will be able to both standardize and personalize the best possible care for our hernia patients,” said Poulose. “This isn’t merely about standardizing procedures. It’s about improving quality of care and, ultimately, quality of life.”

The data are also expected to demonstrate ways to reduce surgical site infections, minimize perioperative pain and identify factors leading to hernia recurrence.

“One of the most exciting elements of this quality collaborative is that the AHSQC is actually going to change the culture of surgery,” said Rosen, co-director of the quality collaborative. “By collaborating amongst surgeons, with the goal of improving the quality of hernia surgery, we will be able to provide the answers to many important questions.”

Building on Vanderbilt’s ongoing quality improvement programs, Poulose will work with David Penson, M.D., MPH, director of the Center for Surgical Quality Outcomes Research, and Roger Dmochowski, M.D., executive medical director for Patient Safety and Quality (Surgery).

The AHS will announce the new collaborative to its members at its annual meeting in Orlando, Fla., in March.

“We formed the American Hernia Society Quality Collaborative to prepare the members of the AHS for the next century, focusing on quality that will ultimately improve patient care. Working in teams, and with support from leading experts and peers, our group has learned and applied the principles and processes of quality improvement,” said Sergio Roll, president of the American Hernia Society.

Media Inquiries:
Mimi Eckhard, (615) 322-4625

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