Optimizing Patient Outcomes: A Multidisciplinary Evidence Based Approach to Abdominal Wall Reconstruction
Ronald E. Hoxworth, M.D., Ronnie A. Pezeshk, M.D., Benson J. Pulikkottil, M.D., Nathaniel E. Schaffer, PhD, Steven Mapula, M.D., Heather D. Conover, RN, Robert V. Rege, M.D., Jeffrey M. Kenkel, M.D..
University of Texas Southwestern Medical Center, Department of Plastic Surgery, Dallas, TX, USA.
Complex abdominal wall reconstruction in the modern age of the affordable care act presents a formidable challenge to the surgeon. The future of medicine will necessitate a multidisciplinary approach to justify the treatment of many complex medical issues including abdominal wall reconstruction. In this manuscript, we outline our approach to complex abdominal wall reconstruction and demonstrate improved outcomes when utilizing a multidisciplinary approach.
A retrospective analysis was carried out on patients that presented for open abdominal hernia repair performed by a single surgeon. Two groups of patients were compared: one arm consisted of 100 randomly selected patients who underwent an "optimized" treatment program, which is described in the discussion section, and the other arm consisted of 100 randomly selected "non-optimized" patients who
underwent hernia repair prior to the implementation of the structured multidisciplinary program.
The number of patients suffering a recurrent hernia was significantly reduced among optimized patients with the recurrence rate falling from 28% to 12% with optimization (p < 0.01).
A multidisciplinary team of specialists employing an evidence based plan of care can identify risk factors, create standardized protocols, and optimize patient outcomes. Standardized care increases efficiency, patient safety, and resource utilization, and the Abdominal Wall Reconstruction Program described provides objective data in support of this evidence-based approach to healthcare.
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