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

Bradley Stephan, Bruce Ramshaw, Brandie Forman

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalSurgical technology international
Volume26
StatePublished - May 1 2015
Externally publishedYes

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Abdominal Wall
Quality Improvement
Ventral Hernia
Abdominal Muscles
Costs and Cost Analysis
Pain Management
Hernia
Local Anesthetics
Sweden
Length of Stay
Delivery of Health Care
Pharmaceutical Preparations
Incisional Hernia

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction. / Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie.

In: Surgical technology international, Vol. 26, 01.05.2015, p. 135-142.

Research output: Contribution to journalArticle

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