Real-World Clinical Quality Improvement for Complex Abdominal Wall Reconstruction

Bruce Ramshaw, Brandie Remi Forman, Karla Moore, Robert Heidel, Michael Fabian, Gregory Mancini, Girish P. Joshi

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: Traditional methods of clinical research may not be adequate to improve the value of care for patients undergoing abdominal wall reconstruction (AWR). These patients are prone to high complication rates and high costs. Here, we describe a clinical quality improvement (CQI) effort to enhance outcomes for patients undergoing AWR. MATERIALS AND METHODS: CQI was applied for the entire care cycle for consecutive patients who underwent AWR from August 2011-September 2015. Initiatives for improving value during this period included use of long-term resorbable synthetic mesh as well as administration of preoperative bilateral transversus abdominus plane (TAP), and intraoperative abdominal wall blocks using long-acting bupivacaine as a part of a multimodal regimen. Outcomes data that measure value in the context of AWR were collected to compare outcomes for the patients who received TAP blocks only, TAP and intraoperative blocks, and those who received no block. RESULTS: One hundred and two patients who had AWR for abdominal wall pathology were included. Outcomes including total opioid use, duration of stay and opioid use in the postanesthesia care unit (PACU), length of hospital stay (LOS), major wound complications, and costs, all improved over time. Specifically, PACU opioid use, total opioid use, and LOS were decreased in the two groups that received blocks versus a group that did not have any type of block. CONCLUSIONS: CQI program implementation in patients undergoing AWR resulted in measurable improvement of value-based outcomes over time. A CQI effort applied to the entire patient cycle of care should be routinely utilized.

Original languageEnglish (US)
Pages (from-to)155-164
Number of pages10
JournalSurgical technology international
Volume30
StatePublished - Jan 13 2017
Externally publishedYes

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Abdominal Wall
Quality Improvement
Abdominal Muscles
Opioid Analgesics
Length of Stay
Patient Care
Costs and Cost Analysis
Bupivacaine
Outcome Assessment (Health Care)
Pathology
Wounds and Injuries
Research

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Real-World Clinical Quality Improvement for Complex Abdominal Wall Reconstruction. / Ramshaw, Bruce; Forman, Brandie Remi; Moore, Karla; Heidel, Robert; Fabian, Michael; Mancini, Gregory; Joshi, Girish P.

In: Surgical technology international, Vol. 30, 13.01.2017, p. 155-164.

Research output: Contribution to journalArticle

Ramshaw, Bruce ; Forman, Brandie Remi ; Moore, Karla ; Heidel, Robert ; Fabian, Michael ; Mancini, Gregory ; Joshi, Girish P. / Real-World Clinical Quality Improvement for Complex Abdominal Wall Reconstruction. In: Surgical technology international. 2017 ; Vol. 30. pp. 155-164.
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