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Hao CZ, Tang SS, Lee SKF, Parameswaran R, Lomanto D, Loo LMA, Wijerathne S. An update to the "modified-TEP (mTEP)" technique. Hernia 2024:10.1007/s10029-024-03146-1. [PMID: 39294477 DOI: 10.1007/s10029-024-03146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/13/2024] [Indexed: 09/20/2024]
Affiliation(s)
- Chia Zhong Hao
- Department of General Surgery, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Sarah S Tang
- Department of General Surgery, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Sean K F Lee
- Department of General Surgery, National University Hospital, National University Health System, Singapore, Singapore
| | - Rajeev Parameswaran
- Department of General Surgery, National University Hospital, National University Health System, Singapore, Singapore
| | - Davide Lomanto
- Department of General Surgery, National University Hospital, National University Health System, Singapore, Singapore
| | - Lynette M A Loo
- Department of General Surgery, National University Hospital, National University Health System, Singapore, Singapore
| | - Sujith Wijerathne
- Department of General Surgery, Alexandra Hospital, National University Health System, Singapore, Singapore.
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Tan L, Lim J, Lee J, Loo L, Lomanto D, Parameswaran R, Shabbir A, Murphy D, Kumari S, Wijerathne S. The impact of value-driven outcomes initiative on endo-laparoscopic groin hernia repair. Hernia 2023; 27:1299-1306. [PMID: 36427167 DOI: 10.1007/s10029-022-02717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Value driven outcome (VDO) initiative is a value-based, patient-focused tool which utilizes a clinical outcome-based approach to optimize value of care based on clinically relevant quality indicators and costs required to achieve the care. In this study, we evaluate the impact of a VDO initiative on groin hernia repair, a commonly performed elective surgery in our hospital. METHODS A VDO initiative was implemented in 2019 to encourage elective inguinal hernia repair to be performed at a day surgery setting. A comparison of outcomes was made between hernia surgeries performed in 2019 with those in 2020 and 2021. Pre-defined criteria were used to select patients that can be operated at a day surgery setting. Patients' expectations were addressed preoperatively about day surgery procedure and postoperative recovery. Day surgery bundles were used to standardize pre- and post-surgery protocols. Pain control was optimized using a specialized local anesthesia regime. RESULTS A total of 263 laparoscopic hernia surgeries were performed between May 2019 and December 2021. After implementation of VDO initiative, the percentage of patients discharged within 24 h increased from 78% in year 2019 to 97% in year 2020 and 99% in year 2021. Conversion rate for day surgery to short stay decreased from 9% in year 2019 to 1% in year 2020 and 2% in year 2021. In 2019 to 2021, there were no 30-day readmission, no hernia recurrence in 90 days, no conversion to open surgery. CONCLUSION VDO initiative is a promising tool to deliver better value-based care for patients undergoing endo-laparoscopic inguinal hernia repair.
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Affiliation(s)
- Lydia Tan
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Joseph Lim
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - James Lee
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Lynette Loo
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Davide Lomanto
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Rajeev Parameswaran
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Asim Shabbir
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Diarmuid Murphy
- Value Driven Outcome Office, National University Health System, Singapore, Singapore
| | - Shikha Kumari
- Value Driven Outcome Office, National University Health System, Singapore, Singapore
| | - Sujith Wijerathne
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore.
- Department of Surgery, National University of Singapore, Singapore, Singapore.
- Department of Surgery, National University Hospital, Level 8, NUHS Tower Block,1E Kent Ridge Rd, Singapore, 119228, Singapore.
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Comment to: feasibility of modified‑TEP technique for large inguinoscrotal and large femoral hernia and its advantages. Hernia 2022; 26:1191-1192. [PMID: 35748960 DOI: 10.1007/s10029-022-02648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/21/2022] [Indexed: 11/04/2022]
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Wijerathne S, Lomanto D. Comment to: feasibility of modified-TEP technique for large inguinoscrotal and large femoral hernia and its advantages. Author's reply. Hernia 2021; 26:669-670. [PMID: 34791553 DOI: 10.1007/s10029-021-02539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Affiliation(s)
- S Wijerathne
- Department of General Surgery, National University Health System, Singapore, Republic of Singapore. .,General Surgery Service, Alexandra Hospital, National University Health System, Singapore, Republic of Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore. .,Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, National University Health System (NUHS), Level 8, NUHS Tower Block, 1E Kent Ridge Road 119228, Singapore, Republic of Singapore.
| | - D Lomanto
- Department of General Surgery, National University Health System, Singapore, Republic of Singapore.,General Surgery Service, Alexandra Hospital, National University Health System, Singapore, Republic of Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
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Feasibility of modified-TEP technique for large inguinoscrotal and large femoral hernia and its advantages. Hernia 2021; 26:667-668. [PMID: 34665342 DOI: 10.1007/s10029-021-02526-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
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