What do you mean by ‘patient outcomes’?

Each medical specialty measures patient outcomes in different ways. For hernia patients, we measure patient outcomes in 4 major categories:

• Minimizing recurrence rates – or the chance the hernia will return
• Maximizing quality of life of each patient after their surgery – and in turn minimizing chronic pain
• Minimizing immediate post operative complications – including infections, bleeding, unschedule returns to the operating room, etc.
• Minimizing opioid usage

These four categories are what we designate as our ‘Patient Outcomes’.

How do you track your patient outcomes

We have been a part of the Abdominal Core Health Quality Collaborative (ACHQC) for over 8 years. During these years, we have entered all of our hernia patients into the database. These patients then complete follow up surveys at 6 months, 1 year, and yearly thereafter which tracks the 4 major patient outcomes discussed above.

How do patient outcomes help future patients?

In the end, the outcome you have after your hernia surgery will be the only thing that matters. If you choose a surgeon who has high recurrence rates and increased chronic pain you can expect a higher than average chance of having a poor outcome. If you choose a hernia surgeon who has low recurrence rates and high quality of life ratings for patients after their surgery, you will have a statistically better chance of having a desirable outcome after your surgery.

Obviously, the problem that many patients face is how to find a surgeon who falls into the later category! Traditionally, hernia patient outcomes is not something that most surgeons track and even fewer publish for patients to review. However, by publishing our patient outcome data, patients can make more educated decisions on who to trust with their hernia care.

How is the patient outcome data collected?

Hernia recurrence rates are based on Patient Reported Outcomes (PRO). These PRO are patient’s answers to questions on the follow up surveys provided at 30 days, 6 months, and then yearly thereafter. Patients who indicate that their hernia ‘may have come back’ are considered to have a recurrent hernia.

While this is the most sensitive way to measure hernia recurrences since they identify almost every patient who MIGHT have a recurrent hernia, it is the least accurate way to ensure that a patient actually HAS a recurrent hernia. Many of these patients do not seek care for a hernia that they think might have come back. And those that do often are examined and reassured that their hernia has not returned. Or the appropriate imaging is performed to rule in or out a recurrent hernia.

Are the data and the outcomes that you publish accurate?

The recurrence rates which we calculate for all surgeons is skewed towards much higher numbers than is usually reported in medical studies which use physical exam and imaging to diagnose recurrent hernias. Therefore the measured and indicated recurrence rates in the ACHQC data is higher than we know to be accurate and is overall not useful by itself. Medical studies consistently demonstrate a recurrence rate of 1-2% for most initial hernias.

However, what is useful is each surgeon’s data compared with the whole. If a surgeons recurrence rate or pain scores are higher or lowers than the national average in this data, they almost certainly will be higher/lower than 1-2%.

How do I compare your data to other surgeons?

What is useful is each surgeon’s data compared with the whole. If a surgeons recurrence rate or pain scores are higher or lowers than the national average in this data, they almost certainly will be higher/lower than 1-2%.

It is also important to keep in mind that surgeons who participate in the ACHQC and track their data are typically surgeons who make hernia repairs a priority in their practice. Even compared against these leaders, our numbers show improved outcomes across the board. When compared to surgeons who do not prioritize hernias and who are not tracking their data, we feel that our outcomes data would be even more compelling.

How do I check other surgeons patient outcomes data?

Each surgeon across the country has the option of participating in either the ACHQC, or a similar database, to track their outcomes. By entering their data into a comprehensive collaborative, that data can help track a variety of outcomes similar to the ones that we track.

When considering where to have your hernia care, patients can inquire to potential surgeons so see if they have published data on their outcomes or specific tracking mechanisms in place to provide ongoing outcomes. Some surgeons will be able to provide similar outcome data while many will unfortunately not be able to do so.

What is your recurrence rates after an initial hernia repair based on your patient outcome data?

Our recurrence rates for an inguinal hernia are 4.76%. The national average for other surgeons within the ACHQC is 7.97%. Thus our patients have a 41% reduction in recurrence rate when compared to the ACHQC as a whole. This is represented in the table below.

Our recurrence rates for ventral hernias is 4.0% while the national average is 22.3% Our patients have a 82% reduction in recurrence rate when compared to the ACHQC as a whole.

Please keep in mind that our ventral hernia repair data is being compared against other surgeons and patients across the country. Some patients at other centers have much more complicated hernias and are being done at large University type centers. This clearly can skew our data which tends to include healthier patients with less complicated hernias towards having a lower complication and recurrence rate. Ventral hernia repair data can thus be difficult to accurately compare between surgeons and their specific patient populations.

What is your Quality of Life outcomes based on your data?

Quality of life data represents how patients can expect to feel after a specific period of time after their hernia surgery. In addition to minimizing recurrence rates, how a patient feels is probably the most important factor to consider as an outcome.

Our patients quality of life is a 2 while the national average is 3. Thus, our patients feel 33% better at 6 months when compared to the ACHQC as a whole.

*Lower EuraHS score means better QoL and higher EurasHS score means worse QoL.

Our patients score a 91.6 for quality of life while the national average is 88.4. Therefore our patients feel 3.6% better at 2 years when compared to the ACHQC as a whole. *Higher HerQLeS score means better QoL and lower HerQLeS score means worse QoL.