Quality improvement (QI) is a very important part of modern healthcare. Quality improvement involves following all patients, with a particular problem, from the time they begin treatment until they are at a point in time when they are no longer likely to have complications. There are many QI projects that are ongoing in the United States. Many QI programs are sponsored by the federal government, often through Medicare, while others are sponsored by insurance companies or professional medical organizations.
NSQIP Is a surgical quality improvement program sponsored by the American College of Surgeons, the main professional organization for general surgeons. NSQIP follows patients up to 30 days after surgery. Trained nurses review hospital and office records for potential complications that may occur after surgery. NSQIP reviews many different types of surgery such as gallbladder, intestinal, colon and hernia surgery. The program is excellent and has led to many improvements in surgical care. The program is designed to capture the majority of complications after a majority of different types of surgeries. The program is very good at identifying things like wound infections, stroke, heart attack, etc., since most of these issues will occur within a short time after surgery itself.
The main limitation of the program is that it cannot find problems that occur after the first month of surgery. This is a severe limitation for patients undergoing hernia surgery since the most significant problems after hernia surgery, chronic pain and hernia recurrence (hernia coming back), don’t typically occur until about 6 months after surgery. Hernia recurrence is possible after any type of hernia repair surgery and can occur months to years after surgery. The highest risk is within the first 5 years after surgery.
The AHSQC is a quality improvement initiative sponsored by the American Hernia Society, the primary professional organization for surgeons who have a specific interest in treating patients with hernias.
The AHSQC was designed by surgeons to address the major limitation of current QI programs, the 30 day limit, for patients specifically with hernia disease. Patients with incisional hernias are eligible for participation at the present time. Basic patient medical information (Diabetes, High blood pressure, smoking,etc) and the type and size of hernia as well as the manner in which it is fixed are recorded in a secure national database. After surgery, patients are followed normally by their surgeon in the office. Importantly, the AHSQC intends to continue following patients for many years after surgery. Patients are contacted yearly, via email, and asked to take a brief survey that is designed to help detect hernia recurrence and assess quality of life issues. This type of program has never been undertaken before anywhere in the world.
Currently, most scientific data regarding hernia repair comes from individual or small groups of surgeons and only contains a limited number of patients. Although this type of science is helpful, better data can be obtained when we look at thousands of patients over the course of several years. This can only be accomplished through programs like the AHSQC.
Dr. Janczyk and Dr. Iacco have always been committed to improving patient care through quality improvement processes. He has and continues to participate in major national quality programs for many different types of patients including: the National Trauma Data Bank (NTDB), the Michigan Trauma Quality Improvement Program (MTQUIP), and NSQUIP.
Dr. Janczyk and Dr. Iacco have partnered with William Beaumont Hospital-Royal Oak to become one of the first national and the first Michigan site for participation in the AHSQC.
Because of his expertise and dedication to the care hernia patients, Drs. Janczyk and Iacco maintain a high volume hernia surgery practice and contributes as one of the busiest participating centers in the US (blue bar below).
We treat both simple “routine” hernias as well as very complex hernias. As seen below (in blue), many of our patients have common medical conditions and risk factors that may make their hernia surgery more difficult. A large proportion of our patients have recurrent hernias and/or suffer from obesity, smoking and diabetes. These factors are known to increase the risk of post op complications and hernia recurrence.
Since the way any individual human body will heal is unknown, no surgery can be 100% guaranteed. However, we are committed to minimizing complications and maximizing functional results for our patients. As seen below (in blue), although our patients tend to be more complicated, compared to national averages, we are able to maintain post op complications rates lower than national averages (green bars), including risk of post op infection or wound complications as well as other complications such as cardiac or respiratory issues.