Can hernia repair rates be reduced?

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I was told by a widely traveled surgeon that in Africa the single most useful intervention that you could do was to repair an inguinal hernia and return a person to productivity.  Makes sense to me. As to even umbilical hernias it really depends on a multiplicity of factors but even then I would say 50% cosmetic is way high

R Wigle MD FACS
LSU Shreveport

--- On Thu, 4/28/11, cpiras <cpiras at uol.com.br> wrote:

From: cpiras <cpiras at uol.com.br>
Subject: Re: Can hernia repair rates be reduced?
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Date: Thursday, April 28, 2011, 7:38 AM

Probably it is correct for umbilical hernias. I do not agree for the others.

Claudio Piras, MD PhD
Department of Surgery
Federal University of Espirito Santo
Brazil




Em 28/04/2011 06:18, Dmitri Nepogodiev < dnepogodiev at googlemail.com > escreveu:
This isn't directly related to trauma but I thought there might be some 
interesting discussion on this topic.

The NHS in England is expected to make efficiency savings of £20bn over 
the next few years. In February 2009 McKinsey were commissioned to 
outline how savings might be achieved. One area where McKinsey suggested 
savings might be made were surgical procedures with "limited clinical 
benefit."

McKinsey described hernia repairs as "potentially cosmetic 
interventions". They proposed that reducing the numbers of inguinal, 
umbilical and femoral hernias operated by 25-50% would save 
£24.8-£49.5m. Similarly, reducing incisional and ventral hernia repairs 
by 10-75% would save £3.4-25.5m.

An Audit Commission report published this month looks at how savings can 
be made on "low c
 linical value treatments". The report focuses on 
Croydon PCT's list of "low priority treatments" that has been adopted by 
other commissioners too. Under the same heading "potentially cosmetic 
procedures" this retains reference to reducing all hernia repair rates.

I wonder if those of you who operate on hernias can agree that up to 
half (or more) of such cases are unnecessary and performed for primarily 
cosmetic purposes? Quite apart from the impact of symptomatic hernia on 
patient quality of life, I would be interested if any of you would be 
concerned that a reduction in operating rates would cause an increase in 
complication rates? Might the impact of this outweigh the initial cost 
savings?

Regards

Dmitri


McKinsey report on the fiscal future of the NHS
http://www.dh.gov.uk/en/FreedomOfInformation/Freedomofinformationpublicationschemefeedback/FOIreleases/DH_116520

Reducing expenditure on low clinical value treatments
http://www.audit-commission.gov.uk/nationalstudies/health/financialmanagement/lowclinicalvalue/Pages/Default.aspx 

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