Dissecting clinical practice variation and long-term patient outcomes in hernia surgery

Abstract

Abdominal wall hernia repair is a common elective operation in Australia, with over 90000 procedures performed annually. This thesis explores the complexity of decision-making involved in hernia surgery, impact on healthcare expenditure, and long-term patient-reported outcomes. It highlights the need for changes in clinical practice for hernia management in Australia to improve patient outcomes and optimise the use of healthcare resources.

Several key recommendations include the need to improve same-day inguinal hernia repair rates to align with international guidelines and to develop local consensus guidelines for hernia management. Addressing regional variations in groin hernia management is crucial due to its cost implications and potential impact on patient outcomes based on location, necessitating healthcare reforms and standardised clinical pathways.

The thesis found ANZ surgeons prefer minimally invasive techniques and overnight stays for inguinal and small ventral hernia repairs, despite evidence supporting same-day repair. Additionally, establishing guidelines for communication practices after hernia repair may improve informed consent discussions and bridge the communication gap between surgeons and referring doctors. Due to the lack of a universal approach to hernia management and limited long-term follow-up data, it is crucial to use Patient-Reported Outcome Measures to thoroughly assess the long-term impact on the quality of life for hernia patients.

This thesis proposes a comprehensive approach to reducing variations in hernia management in Australia. Some key interventions include patient and surgeon education, financial incentives for same-day hernia surgery, and fostering collaboration among multiple stakeholders to achieve better patient outcomes. The success of these interventions depends on the support of the Royal Australasian College of Surgeons, public and private hospital associations, insurance companies and consumer advocacy groups.