Todd Heniford, MD, FACS is the Chief, Division of Gastrointestinal & Minimally Invasive Surgery and Professor of Surgery at Carolinas HealthCare System in Charlotte. He is also a leading proponent of using surgical outcomes data to support operative decisions.
We caught-up with Dr. Heniford of North Carolina, who runs a large clinical practice for hernia and abdominal wall surgeries, at a recent AWR conference in Washington, DC. He received this year’s top industry award from his colleagues: The GeorgetownMedstar Award – Lifetime Achievement in Abdominal Wall Reconstruction.
“No one gets an award after a failed hernia repair,” he said. “So careful consideration of biosynthetics – like TIGR Matrix Surgical Mesh and the others — is a very important part of this conference at AWR.
“We have won lots of research awards and many are translational — patient questions that go to the lab and lab answers that then come back to the patient,” said Dr. Heniford. “We have data from 7400 prospective patients in our database. This allows us to examine technique, mesh choices, and even at-risk patients and those factors that impact their outcomes. Data is beneficial in guiding our approach and directing patient discussion. Mesh choice and patient selection — where do you put the mesh and how do you secure it — is part of the dialogue.
“We have developed an app, named CeDAR, that is a predictive algorithm — its greatest value is to help surgeons talk to patients about preventing complications and the role the patients themselves can play in that effort,” said Dr. Heniford. “Patients and physicians can make more informed decisions.”
He said he and his AWR specialist colleagues are seeing more evidence-based, consumer-driven choice in biosynthetics. It is not about marketing but it is about data and TRUTH. Consumers may be able to choose their mesh in the future if given that choice.
“I may be drawn to a car due to marketing around that car, but we need to see how the car performs,” he said. “I want patients’ choices as informed as possible — I try to explain what we know according to the current scientific information available. Marketing should play no role in our healthcare delivery. What are the true expected outcomes?”
For example, he said: “I think our quoted recurrence and infection rates are higher now than reported in the past. The reason is not because we are poor surgeons; we appear more frank in reporting outcomes and have more complete data and patient follow-up.
“Push your hubris and ego to the side,” he asked his fellow surgeons. “We need a new baseline, an honest baseline. It used to be surgeons would thump their chests and attempt to show-off their near perfect surgical data. But that is not helpful. We can only progress if we truly know our recurrence and complication rates in difficult abdominal wall reconstruction cases.”
Dr. Heniford said this as a straightforward surgeon. He believes AWR doctors can look at hernia repair in a new way.
“Most surgeons do not really know what their long term outcomes are because they do not have a formal follow-up or data gathering program,” said Dr. Heniford. “Approximately 70 percent of patients with failed hernia repairs or complications do not return to their original surgeon.”
A British journal of surgery says that surgeons underestimate their complication rate by as high as two-thirds. These surgeries had significantly greater complications than the doctor had anticipated.
“I am excited about the future,” said Dr. Heniford. “Big data and other advances, like Biosynthetic surgical mesh, are the newest and hottest thing.”
Mike Smith writes for Huffington Post Healthy Living, Medical Design Technology and PMFA journal
Dr. Todd Heniford’s latest article on Hernia repair strategies will be running in Surgical Technology International’s 25th anniversary issue. The article “The Current Status of Biosynthetic Mesh for Ventral Hernia Repair” will publish in October. Novus Scientific will be distributing reprints of this journal article throughout this month at the American Society of Plastic Surgery “The Meeting” in Chicago and at the American College of Surgeons meeting in San Francisco.
Here is the story as it appeared in Becker’s GI and Endoscopy: http://www.beckersasc.com/news-analysis/physicians-can-learn-from-their-mistakes-data-drives-better-decision-making.html