Williams Kristopher B, Belyansky Igor, Dacey Kristian T, Yurko Yuliya, Augenstein Vedra A, Lincourt Amy E, Horton James, Kercher Kent W, Heniford B Todd
Carolinas Medical Center, Charlotte, NC, USA.
Anne Arundel Medical Center, Annapolis, MD, USA.
Surg Innov. 2014 Dec;21(6):572-9. doi: 10.1177/1553350614528579. Epub 2014 Apr 14.
Creating a surgical specialty referral center requires a strong interest, expertise, and a market demand in that particular field, as well as some form of promotion. In 2004, we established a tertiary hernia referral center. Our goal in this study was to examine its impact on institutional volume and economics.
The database of all hernia repairs (2004-2011) was reviewed comparing hernia repair type and volume and center financial performance. The ventral hernia repair (VHR) patient subset was further analyzed with particular attention paid to previous repairs, comorbidities, referral patterns, and the concomitant involvement of plastic surgery.
From 2004 to 2011, 4927 hernia repairs were performed: 39.3% inguinal, 35.5% ventral or incisional, 16.2% umbilical, 5.8% diaphragmatic, 1.6% femoral, and 1.5% other. Annual billing increased yearly from 7% to 85% and averaged 37% per year. Comparing 2004 with 2011, procedural volume increased 234%, and billing increased 713%. During that period, there was a 2.5-fold increase in open VHRs, and plastic surgeon involvement increased almost 8-fold, (P = .004). In 2005, 51 VHR patients had a previous repair, 27.0% with mesh, versus 114 previous VHR in 2011, 58.3% with mesh (P < .0001). For VHR, in-state referrals from 2004 to 2011 increased 340% while out-of-state referrals jumped 580%. In 2011, 21% of all patients had more than 4 comorbidities, significantly increased from 2004 (P = .02).
The establishment of a tertiary, regional referral center for hernia repair has led to a substantial increase in surgical volume, complexity, referral geography, and financial benefit to the institution.
创建一个外科专科转诊中心需要在该特定领域有浓厚的兴趣、专业知识、市场需求以及某种形式的推广。2004年，我们建立了一个三级疝气转诊中心。本研究的目的是考察其对机构业务量和经济效益的影响。
回顾了所有疝气修补手术（2004 - 2011年）的数据库，比较了疝气修补类型、手术量以及中心的财务表现。对腹疝修补（VHR）患者亚组进行了进一步分析，特别关注既往修补情况、合并症、转诊模式以及整形外科的协同参与情况。
2004年至2011年期间，共进行了4927例疝气修补手术：腹股沟疝占39.3%，腹疝或切口疝占35.5%，脐疝占16.2%，膈疝占5.8%，股疝占1.6%，其他占1.5%。年度计费每年从7%增长至85%，平均每年增长37%。将2004年与2011年相比，手术量增加了234%，计费增加了713%。在此期间，开放式VHR增加了2.5倍，整形外科医生的参与增加了近8倍（P = 0.004）。在2005年，51例VHR患者有既往修补史，其中27.0%使用了补片，而在2011年，114例既往有VHR史的患者中，58.3%使用了补片（P < 0.0001）。对于VHR，2004年至2011年州内转诊增加了340%，而州外转诊跃升了580%。2011年，所有患者中有21%患有4种以上合并症，较2004年显著增加（P = 0.02）。
建立一个三级区域疝气修补转诊中心已使手术量、手术复杂性、转诊地域范围以及机构的经济效益大幅增加。
