Department of General Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2022 Sep;92(9):2025-2036. doi: 10.1111/ans.17765. Epub 2022 May 30.
The burden of complex abdominal wall hernia (CAWH) is increasing, with associated high morbidity and healthcare costs. This study evaluates current evidenoptce regarding multidisciplinary care for CAWH patients to improve patient outcomes.
A systematic review of Scopus, MEDLINE, Embase, PubMed, Web of Knowledge and Cochrane Library was conducted to identify proposed or established multidisciplinary team (MDT) pathways, necessary MDT constituents, and to evaluate patient outcomes. The pre-optimization pathways were then compared with a recent Delphi consensus statement.
Seven articles matched the relevant search criteria. Three were concept articles, without prospective data analysis. Four were case series that applied multidisciplinary care and included limited data analyses with outcomes reported up to 50 months. The consensus was that CAWH MDT requires multiple clinical specialties, including hernia, upper gastrointestinal, colorectal and/or plastic and reconstructive surgeons, along with allied health specialists, radiologists, anaesthetists/pain specialists and infectious diseases consultants. A successful MDT should aim to achieve pre-optimization and plan the definitive repair. These pre-optimization pathways were similar to the recent Delphi consensus by international hernia experts. Using these data, we propose a CAWH multidisciplinary pathway model in an Australian tertiary hospital involving a stepwise approach with well-defined referral criteria, perioperative high-risk management with pre-optimization, surgical planning, postoperative care and follow-up protocols. This pathway incorporates prospective data collection in a Clinical Quality Registry (CQR) to validate its appropriateness.
CAWH MDT can provide comprehensive, patient-centred care with improved postoperative outcomes. CQR are important to better evaluate long-term outcomes and ensure rigorous quality control.
复杂腹壁疝（CAWH）的负担正在增加，其相关发病率和医疗保健费用也很高。本研究评估了当前关于 CAWH 患者多学科护理的循证医学证据，以改善患者的预后。
对 Scopus、MEDLINE、Embase、PubMed、Web of Knowledge 和 Cochrane Library 进行系统检索，以确定提出或建立的多学科团队（MDT）路径、必要的 MDT 组成部分，并评估患者的预后。然后将预优化路径与最近的 Delphi 共识声明进行比较。
有 7 篇文章符合相关搜索标准。其中 3 篇是概念文章，没有前瞻性数据分析。另外 4 篇是病例系列，应用了多学科护理，并对有限的数据进行了分析，结果报告了长达 50 个月。共识是 CAWH MDT 需要多个临床专业，包括疝、上消化道、结直肠和/或塑料和重建外科医生，以及相关的健康专家、放射科医生、麻醉师/疼痛专家和传染病顾问。一个成功的 MDT 应该旨在实现预优化并规划明确的修复。这些预优化路径与国际疝专家的最新 Delphi 共识相似。根据这些数据，我们在澳大利亚的一家三级医院提出了一种 CAWH 多学科途径模型，涉及一个逐步的方法，有明确的转诊标准、围手术期高危管理、预优化、手术计划、术后护理和随访方案。该途径纳入了临床质量登记（CQR）中的前瞻性数据收集，以验证其适宜性。
CAWH MDT 可以提供全面的、以患者为中心的护理，改善术后结果。CQR 对于更好地评估长期结果和确保严格的质量控制非常重要。
