On Monday April 27, Dr Bruce Ramshaw presented data from the clinical quality improvement (CQI) program performed at Halifax Health Center in Daytona Beach, Florida. Several attempts at process improvement were implemented in one hernia program over a three-year period. For 63 consecutive cases of patients undergoing abdominal wall reconstruction, these improvement attempts included using a long-term resorbable synthetic mesh (TIGR Matrix) instead of a biologic mesh, applying new surgical techniques, and implementing an improved pain management strategy. This surgically complex patient population included prior or current wound and mesh infections, patients with loss of abdominal domain, recurrent hernias and patients with intraoperative contamination. Using value defined as improving quality outcome measures while decreasing costs, outcomes were determined, measured and compared to results obtained prior to each process improvement attempt.
For cost-of-mesh data, the real cost savings for the 63 cases following the use of TIGR Matrix long-term resorbable mesh were an average of USD 8744 per patient compared with continuing to use the previous biologic mesh. New surgical techniques and pain management strategies implemented after the 17th patient led to a 64% post-operative reduction in the use of opioids and a 34% decrease in the average length of stay.
Dr Ramshaw concluded that in this real-world, value-based application of CQI, the described attempts at process improvement decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral / incisional hernias.