Hernia Repair Surgery Outcomes Improved For High-Risk Patients With “Optimization” Program: Study

Implementing an intervention clinic for patients who need hernia surgery, but are not eligible for the procedure since they are considered “high risk”, helped to increase the number of patients who are able to safely undergo a hernia repair and reduced the risk of hernia complications, according to the findings of a new study.

Patients undergoing any type of surgery face an increased risk of complications or death if they undergo anesthesia or surgical interventions. This study focused on implementing interventions to help patients become eligible for procedures if they are considered high risk, and reduce their risk of complications during surgery.

The a study published this week in the medical journal JAMA Network Open, University of Michigan researchers enrolled patients seeking elective hernia repair surgery, who were identified as high-risk, and conducted a weekly preoperative optimization clinic in 2019, at a single academic center.

Patients who were referred were considered high-risk for certain factors, such as a body mass index greater than or equal to 40, being 75 years or older, active tobacco users or regular users of other substances.

As part of the trial, participants met with a doctor and agreed to an “individualized optimization goal.” They had in-person and telephone follow-up appointments every 6 to 8 weeks, and there was no limit or minimum number of visits patients could make to the clinic.

A total of 165 patients were included in the preoperative clinic. Among high-risk patients, 37% of patients were overweight, 26% used tobacco, and 24% were older than 75 years. Doctors focused on helping to reduce patient risk factors without increasing the patient risk to surgery.

One year after the implementation of the preoperative optimization clinic, 9% of high-risk patients became eligible for hernia surgery because they met their optimization goals.

Of the 15 patients who became eligible for surgery after meeting their clinic goals, 12 patients were eligible because they achieved the health goals they set at the clinic.

Eight patients became eligible because they quit smoking, three patients became eligible because they lost weight and reduced their body mass index and three patients who were older became eligible after improving their functional status.

Roughly 3% of patients in the study experienced a complication or required emergency procedures. While the study was small, this is a lower rate of complications than usual, the researchers noted.

The low-cost optimization clinic helped manage high-risk patients and prepare them for hernia surgery, the researchers concluded.

More than 350,000 hernia surgeries are performed each year in the United States. The surgery, although overall it is a low-risk surgery, can be high-risk for some patients with certain risk factors. For those patients, they can face increased risk of suffering serious complications or even death.

Roughly 25% of patients are considered high-risk and may be denied surgery because of certain risk factors. Patients who fail to undergo necessary surgeries can experience lower quality of life, which may include suffering unnecessary pain and other side effects.

“Although the preoperative period represents a unique opportunity to motivate patient health behavior changes, fear of emergent presentation and financial concerns are often cited as clinician barriers to optimization,” wrote study authors. “This represents an opportunity to create sustainable and scalable models that provide longitudinal care and optimize patients to improve outcomes of hernia repair.”

The findings come as  hernia mesh lawsuits are being pursued over design defects associated with polyproylene products sold by several companies in recent years, including Atrium, Bard, Ethicon, Covidien and others.