York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK.
Department of Plastic Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK.
Hernia. 2021 Apr;25(2):267-275. doi: 10.1007/s10029-020-02354-9. Epub 2021 Feb 18.
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.
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.
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.
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.
临床路径在医疗保健中广泛存在，可能与提高临床疗效、改善患者护理、简化服务有关，同时为患者管理提供明确性。这些路径在多个医疗保健服务领域已经得到很好的建立，但据作者所知，在复杂腹壁重建（CAWR）中尚未建立。本文提出了一种用于管理复杂腹壁疝（CAWH）患者的逐步、结构化和全面的方法，该方法已在我们的实践中成功实施。
对 Embase®和 MEDLINE®等常见数据库进行文献检索，以确定 CAWH 路径是否存在综合路径。因此，我们通过检查当前证据和逻辑，反复开展工作，以对我们自己的路径进行务实的重新设计，从而开发了约克腹壁单位（YAWU）。引入我们的路径后，我们对我们信托机构中随时间推移进行的腹壁病例的复杂性和数量进行了回顾性分析。
我们描述了我们的路径，并证明在约克腹壁单位，病例的数量及其复杂性（根据 VHWG 分类定义）随着时间的推移而增加。
为复杂腹壁疝服务建立结构化路径是改善患者体验和简化服务的一种方式。本文还讨论了路径对于疝外科医生的相关性，并为那些希望在自己的单位建立类似个性化路径的人提供了有用的指导，并允许他们扩大服务范围。
