Calculate your risk, and a guide to mastering hernia repair

[DrBrown]

[USER=”1391″]UhOh![/USER]
I agree that with proper coding more accurate information about mesh problems would be available.
But I am not going to hold my breath.
​​​​​​​Bill Brown MD

[UhOh!]

quote DrBrown:

I agree completely. Without proper codes and documentation we do not know how often mesh has to be removed.
I have not found any articles in the medical literature that give a real number. Without information we can not calculate the cost in terms of dollars and pain and suffering.
Bill Brown MD

I’ve also wondered from time to time whether there should be separate codes for primary vs. recurrent hernias and a special post-operative groin pain code? For those who don’t return to their original surgeon for a recurrence, or with subsequent pain, this would seem to be the best way to track the incidences of each. Surgeons can only report recurrences they know of, and if their repair failed to fix the problem the first time, it stands to reason patients would subsequently go elsewhere, contributing to an artificially low recurrence rate.

[Good intentions]

quote saro:

it is recommended to me because I have waited too long and my hernia can only be contained with a mesh or with non-absorbable sutures
the latter are never absorbed, while the biological one takes a year
good question huh?

I would not conflate the cause of all of the hernia repair problems down to the use of synthetic material in the body. The rise of the long-term hernia mesh problems seems to follow the rise in coverage of larger internal areas with mesh, and with the laparosocpy used to do so. Those three things have grown together over the years. Mesh problems, mesh area coverage, laparsocopy. The dissection of large areas to implant absorbable mesh might have similar problems to synthetic mesh, just due to the exposure of so much area to place the mesh. Without proper long-term studies, everyone is just trying new “stuff” and hoping.

Ask the person proposing the use of the absorbable mesh why they think it’s better and what proof that they can show you that it is better, compared to other options. Don’t take short-term results as worth much. If they refer back to device maker data, be very suspect. The device makers are selling product, not curing patients. The faster that they get to market the more money they make.

Good luck. Get second and third opinions, even if you respect the first surgeon’s work.

[saro]

quote Good intentions:

Hello saro. I just clicked on the link and it opened. It opens to a page where you need to check two boxes (“I am not a robot” is one) to get to the next page.

If you use Google and search for “ACS NSQIP Surgical Risk Calculator” it should be the first result. Maybe that will work.

hello Good intentions, thank you it worked. I have your ideas about the mesh, but I’m not as ‘expert’ either. in another post you mention the case of a semi-absorbable prosthesis, of which the permanent half will then be a problem. . But in the case of a completely absorbable, biological collagen, how does it behave in a year from absorption?
the idea scares me, but it is recommended to me because I have waited too long and my hernia can only be contained with a mesh or with non-absorbable sutures
the latter are never absorbed, while the biological one takes a year
good question huh?

[Good intentions]

quote saro:

Please Good intention, you can check the first link (http://riskcalculator.facs.org/RiskCalculator/), because I can not open it, while for the second everything is fine

Hello saro. I just clicked on the link and it opened. It opens to a page where you need to check two boxes (“I am not a robot” is one) to get to the next page.

If you use Google and search for “ACS NSQIP Surgical Risk Calculator” it should be the first result. Maybe that will work.

[Chaunce1234]

Another way to ‘calculate your risk’ of pain after inguinal hernia surgery is with an app called CeQOL, available for all major phones. I don’t know how accurate it is, but it attempts to quantify chronic pain risk after you answer a few questions. I think it assumes a mesh hernia repair since that is the most common, I am not sure if the risk would be different with non-mesh hernia repair.

It’d be interesting to know if surgeons find the CeQOL app to be a good estimation of chronic pain risk. The risk percentage chance shown is usually high, at least in my opinion.

For iPhone

https://itunes.apple.com/us/app/ceqol-inguinal-hernia/id566313832

For Android

https://play.google.com/store/apps/details?id=com.carolinas.CeQOL&hl=en_US

There is also a similar app for assessing risk of complications with ventral hernia repair:

https://play.google.com/store/apps/details?id=org.carolinashealthcare.ventral&hl=en_US

[saro]

quote Good intentions:

I found this calculator on the American College of Surgeons page. It’s interesting. I also found another interesting page when looking for an APC code. 49650 is “Laparoscopy, surgical; repair initial inguinal hernia”. We can pretend that we are surgeons.

According to the calculator, even though I was in excellent shape with low body fat at the time of my surgery, I was “overweight”. My surgery risk was below average.

http://riskcalculator.facs.org/RiskCalculator/

https://www.aapc.com/blog/23842-mastering-hernia-repair-and-mesh-placement/

This passage, below, shows where mesh removal falls in the scheme of the “payers”. These would be the insurance companies. Apparently there is no “mesh removal” code, and mesh removal can’t be claimed as a foreign body removal. Looks like it gets a catch-all, non-specific, code. Maybe we should be lobbying the insurance companies to create a specific mesh removal code so that the correlation will be more clear, showing up in their databases. Even if the specific cause is not known the ratio of implantations to removals might be telling and worthy of action.

“Finally, a surgeon might remove previously implanted mesh without a recurrent hernia repair, such as when the patient has erosion of the skin over the mesh or pain related to the implant. In these cases, you can report the mesh removal separately. Payers do not consider mesh removal a proper foreign body removal. Therefore, you must use an unlisted procedure code, such as 49999, to report the service. Be sure to include a full operative report with your claim that describes exactly what the surgeon did and why it was necessary, and you should suggest a value for the procedure.”

Please Good intention, you can check the first link (http://riskcalculator.facs.org/RiskCalculator/), because I can not open it, while for the second everything is fine

[dog]

Dear Dr.Brown LOVE it .
You are testing freedom of speech in this country to large extend ..sounds like me LOL

[DrBrown]

Dear Jnomesh
I agree with you. And there is too much money involved. Mesh is just a piece of plastic that probably costs a dollar to manufacture. And the mesh companies charge the patient hundreds and sometimes thousand of dollars for the mesh. There is a strong incentive to play down the problems with mesh. And some of the young surgeons have only been trained using mesh.
Bill Brown MD

[Jnomesh]

Need a mandatory national registry for every mesh that gets implanted. It is the only hope of tracking these devices and the complaints and removals. Otherwise it will just be swept under the rug like it is currently being done.
need every surgeon who implants mesh to be just as qualified In removing mesh otherwise they shouldn’t be implanting mesh.
need surgeons currently in school to be trained on pure tissue repairs just as much as mesh repairs.
mesh companies need to put further research into is there a way to repair hernias and have a mechanism that allows the mesh to be easier and safer to be removed should it require doing.
Surgeons need to be trained on how to reward a MRI and cat scan as it pertains to shifted or folded mesh-there are a few out there that can do this-all should be able to or have a place where they can resource scans out that specialize in reading them as it pertains to mean. No reason someone should be in pain for years and he told all is well when after removal they are told the mesh was folded or balled up.
finally need a mesh protocol for patients in pain and for a place surgeons can resource patients to who need further investigations. One surgeons shortcomings shouldn’t prevent a patient from receiving adequate care.
The playing field absolutely needs to be leveled when it comes to mesh repairs and non mesh repairs.
to say it is lopsided now is a understatement

[DrBrown]

I agree completely. Without proper codes and documentation we do not know how often mesh has to be removed.
I have not found any articles in the medical literature that give a real number. Without information we can not calculate the cost in terms of dollars and pain and suffering.
Bill Brown MD