Page 107 - International guidelines for groin hernia management

Hernia

Discussion recurrence, etc.) or patient-related (e.g., quality of life,
There are several examples of RCTs with a major role in patient satisfaction, etc.). Both are important in assessing
advancing the scientific basis of our knowledge and pro- quality and are interrelated. Devising a meaningful, intel-
mote evidence-based groin hernia surgery. 82, 163, 164 Hernia ligible and fair system for collecting data on quality is
registers with high population based coverage, correct data extremely complicated. Difficulties include:
and a great number of unselected patients have the unique Questions with no answers raised for discussion:
possibility to study clinical reality and reflect outcomes in What is measured?
more routine clinical practice.
Which outcomes?
Registry-based studies are therefore important com-
Should risk adjustment be performed?
plements to RCTs. Currently, there are several examples
How should risk adjustment be done (if it is done)?
of evidence-based national registry studies which are
generalizable to the realm of groin hernia Will outcome measurement lead to conservatism in sur-
surgery. 63, 146, 155–159 gical practice?
How are measurements made and are they accurate?
Are data collected accurately and reliably?
Chapter 26
Timing

Outcomes and Quality Assessment When does a valid outcome manifest after an operation?
What follow-up time is required?
How is outcome information collected when routine
D.L. Sanders, H. Eker and J. Bingener
follow-up is not done?
Introduction Practicality

Will outcome data collection significantly add to
Surgical outcome reporting is important in understanding
the postoperative course of patients undergoing different surgeons’ workloads?
types of groin hernia repair. It also serves to clarify how Will outcome data collection significantly add to other
outcomes are affected by preoperative, surgical and post- healthcare workers’ workloads?
operative variables (e.g., comorbidities, mesh type, mesh Will costs be increased?
Who will pay for these cost increases (if they occur)?
fixation method, and others).
KQ26.a What are the currently used methods for mea- How will the data be used and accessed?
suring surgeon-specific outcomes following groin hernia
repair? Data available to the lay public must be both under-
standable and detailed enough to provide valid decision
KQ26.b What are the currently used methods for mea-
suring patient-based outcomes following groin hernia making tools.
Will there be legal implications of outcome data
repair?
collection and dissemination?

Evidence and discussion Will there be regulatory or governmental implications?
A worldwide agenda now exists to ensure high standards in
Seven clinical outcomes assessment tools specific to
surgical practice by public dissemination of the outcomes hernia surgery are in use internationally, 167–174 as is one
of operations. 165, 166 Quality outcome indicators can be 175
patient outcomes assessment tool. Several hernia reg-
either surgeon-specific/clinical (e.g., length of stay,
istries exist (Swedish Hernia Registry, Danish Hernia

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