• Guidelines – are they being followed?

  Posted by Good intentions on October 4, 2023 at 12:18 pm

  I came across an interesting article today. It is about the Guidelines and the ACHQC. It illustrates the power of the document that the EHS created. The community of surgeons needs something, anything, to follow. And that old outdated document is all that they have.

  The authors used the outdated document to assess whether or not surgeons who contributed (voluntarily) to the ACHQC database were following the recommendations. Also very interesting that the authors refer to the “HerniaSurge Group” as an actual entity, even though it does not actually exist anymore. The mythology of some powerful group of experts creating dependable guidelines continues.

  https://f.oaes.cc/xmlpdf/6a669237-c369-417b-bc1f-3bcd712d07bc/mis-2023-26.pdf

  Oyola et al. Mini-invasive Surg 2023;7:26
  DOI: 10.20517/2574-1225.2023.26 Mini-invasive Surgery

  http://www.misjournal.net
  Original Article Open Access
  Are we following guidelines in inguinal hernia
  repair? An evaluation of practice patterns in the
  abdominal core health quality collaborative
  Anna Malysz Oyola, Seth Beeson, Colston Edgerton, William Hope
  Department of General Surgery, Novant New Hanover Regional Medical Center, Wilmington, NC 28401, United States.

  I pulled this table from the article. The number after each descriptor is the percentage of compliance with the specific section of the Guidelines. It’s interesting. Some of the descriptors are too short to really understand what they mean.

  Table 2. ACHQC compliance with strong recommendations for surgical management of inguinal hernias
  Surgical Treatment Recommendations of Inguinal Hernias: (STRONG)
  % Compliance
  Prophylactic antibiotics in open herniorrhaphy only in high-risk environment N/A
  Surgeons should offer anterior and posterior repair options N/A
  Mesh for large direct hernias during TAP/TEPP to decrease recurrence 100
  Surgeon choice on TEP vs. TAPP due to comparable outcomes 99
  Nerve awareness and recognition during herniorrhaphy to avoid chronic pain 96
  Same day elective surgery if timely follow up is organized 92
  Mesh-based repair 89
  Laparoscopic approach for bilateral herniorrhaphy 89
  Femoral hernias to be repaired laparoscopically with mesh 78
  Flat mesh over plug & patch or 3D bilayer 70
  Women with groin hernias to undergo laparoscopic repair with mesh 57
  Shouldice technique in non-mesh inguinal herniorrhaphy 52
  Avoid mesh selection solely based on terms “lightweight” and “heavyweight”, as weight limits are not clearly defined 50
  Local anesthesia for open repair of reducible inguinal hernias 25
  Avoid prophylactic antibiotics in laparoscopic herniorrhaphy 5

  ACHQC: Abdominal Core Health Quality Collaborative; TAP: total extraperitoneal; TAPP: transabdominal pre-peritoneal; TEP: total
  extraperitoneal; TEPP: transabdominal preperitoneal.

  Good intentions replied 1 year, 4 months ago 1 Member · 0 Replies
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