Page 100 - International guidelines for groin hernia management

Hernia

Certified Hernia Centers in Germany: A significant correlation between surgical volumes and
Level 1: Prerequisite to become a hernia center better outcomes was demonstrated in a systematic review
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Requires at least an annual hernia repair volume of 30 of 16 studies. However, this is not the case for all surgical
cases per surgeon registered in the Herniamed registry and interventions. The relationship between caseload and
follow-up. After 1 year at least 90% of all hernia patients mortality held for pancreatic resections but not for col-
must be entered into the Herniamed registry with infor- orectal surgery. 58 It may be that as intervention complexity
mation on comorbidities to allow for case mix variations. increases—requiring an interdisciplinary approach and
Quality outcome measures exist for infections, revisions, advanced complication management—caseload becomes
complications and follow-up rates. more important. However, an interdisciplinary approach or
Level 2: Competence center special complication management is rare in IH repair.
It has higher annual volume stipulations and additional What constitute high- and low-volume centers for IH
requirements for morbidity conferences, pain management repair are unclear, making outcome comparisons difficult.
and documentation (see Table 4). Two large case series reported excellent results concerning
Level 3: Reference center recurrences in TAPP 28 or TEP, 56 but small case series have
It has still higher and more specific annual volume reached similar standards. 59–62 One paper concluded that
requirements and a variety of science- and education-based technique standardization and learning curve completion
requirements. Level 3 (or reference) centers must be able to (of 50–100 cases) are the key parameters for performance
perform all laparoscopic and open techniques for hernia quality. 29
repair and must have formalized cooperative agreements Another study showed that in a high-volume center
with plastic surgeons (see Table 4). (defined as [ 1000 IH repairs/year) well-supervised trai-
All hernia surgeons in the healthcare system must be nees had longer operation times but similar complications
GHS and EHS members and subscribe to Hernia (http:// rates and recurrences when compared with experienced
www.springer.com/medicine/surgery/journal/10029). 52 surgeons. 29 It seems that learning IH repair well in a short

Table 4 Overview of requirements for hernia centers in Germany
Level Level 1 Level 2 Level 3
Competence center Reference center
No of hernia patients Min 30 Min 200 (min 30 incisional Min 250 (min 50 incisional hernia, 5
treated yearly hernia) complex hernias, 5 hiatal hernias)
Science Membership German and European Hernia Yearly attendance at atleast At least two presentations at a hernia
Society, subscription Hernia a one hernia meeting congress or one publication
Education – – Education seminars, guest visits
a
Obligatory for all levels

KQ23.a Does a center’s volume affect IH surgery time period requires a certain caseload. This experience
outcomes? may be easiest to obtain at a high-volume center.

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