A GIRFT team has carried out new research into the volume-outcome relationship for incisional hernia surgery, helping to inform the debate about how best to organise services going forwards.
Incisional hernia is a common complication following abdominal surgery, and the repair of these post-procedural hernias can be complex. GIRFT has identified evidence of unwarranted variation in clinical practice and patient outcomes across providers and surgeons in England, and there is growing recognition that incisional hernia repair requires specialist skills.
The field of abdominal wall reconstruction is a developing subspecialty within general surgery, but more evidence to inform models of service organisation is needed.
The GIRFT research, led by GIRFT Fellow Michael Monaghan (Croydon Health Services NHS Trust), has been published in the journal Hernia.
The study looked at Hospital Episodes Statistics (HES) data for 75,664 people undergoing first repair of incisional hernia across England over a 12-year period. There was a significant relationship between higher surgeon annual volume and lower rates of reintervention surgery at two years and five years, and between higher hospital provider volume and shorter length of stay in hospital. There was no relationship between volume and short-term surgical outcomes, such as early emergency readmission to hospital or early complications of surgery.
The authors concluded that setting minimum surgeon annual volume thresholds or otherwise ensuring that incisional hernia surgery is only conducted by experienced, specialist surgeons is likely to reduce the need for reintervention surgery.
The study was carried out by:
- Michael Monaghan, GIRFT Fellow.
- Mark Cheetham, GIRFT clinical lead for general surgery.
- Rhys Thomas, Croydon Health Services NHS Trust.
- Sam Parker, Croydon Health Services NHS Trust.
- Professor Tim Briggs, GIRFT programme lead and NHS England’s National Director for Clinical Improvement, Elective Recovery and UEC.
- William Gray, GIRFT academic content lead.
