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. 2021 Apr;25(2):267-275.
doi: 10.1007/s10029-020-02354-9. Epub 2021 Feb 18.

A structured pathway for developing your complex abdominal hernia service: our York pathway

O Smith  1 , T MacLeod  2 , P Lim  2 , P Chitsabesan  1 , S Chintapatla  3
Affiliations

A structured pathway for developing your complex abdominal hernia service: our York pathway

O Smith et al. Hernia. 2021 Apr.

Abstract

Purpose: Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors' knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented.

Methods: A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time.

Results: We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit.

Conclusion: A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.

Keywords: Abdominal wall Reconstruction; Abdominal wall hernia; Pathway; Protocol.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
York CAWH Pathway
Fig. 2
Fig. 2
PIL about CAWH surgery
Fig. 3
Fig. 3
The 12-point plan to minimise surgical site infection (SSI) in CAWR
Fig. 4
Fig. 4
Graph illustrating the percentage of overall cases that were VHWG grade 1, 2, 3 or 4, over time
See this image and copyright information in PMC

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