Real-World Clinical Quality Improvement for Complex Abdominal Wall Reconstruction

Area of Science:

• Surgical innovation
• Quality improvement in healthcare
• Patient outcomes research

Background:

• Abdominal wall reconstruction (AWR) patients face high complication rates and costs.
• Traditional clinical research methods may be insufficient for optimizing AWR care.
• A clinical quality improvement (CQI) initiative was developed to enhance AWR patient outcomes.

Purpose of the Study:

• To describe a CQI effort aimed at improving value-based outcomes in AWR.
• To evaluate the impact of specific interventions on patient care and costs.
• To compare outcomes between patients receiving different anesthetic block strategies.

Main Methods:

• A CQI program was applied to the entire care cycle for AWR patients (August 2011-September 2015).
• Interventions included using long-term resorbable synthetic mesh and multimodal anesthesia with preoperative bilateral transversus abdominus plane (TAP) blocks and intraoperative abdominal wall blocks.
• Outcomes data were collected to compare patients who received TAP blocks only, TAP and intraoperative blocks, and no blocks.

Main Results:

• 102 patients undergoing AWR were analyzed.
• Outcomes such as total opioid use, postanesthesia care unit (PACU) opioid use, length of hospital stay (LOS), major wound complications, and costs showed improvement over time.
• Patients receiving anesthetic blocks (TAP or combined) demonstrated decreased PACU opioid use, total opioid use, and LOS compared to those without blocks.

Conclusions:

• CQI program implementation led to measurable improvements in value-based outcomes for AWR patients.
• A comprehensive CQI approach across the entire patient care cycle is recommended for routine utilization.
• This study highlights the effectiveness of targeted quality improvement initiatives in complex surgical procedures like AWR.