Hernias of the abdominal wall are among the most common surgical disorders, with over 350,000 patients requiring repair annually for a total cost of $3.2 billion. Despite their prevalence, outcomes remain poor and variable, with recurrence rates that range between 32% and 63% at 10 years and a 5-fold difference in recurrence rates between surgeons.1 With the introduction of new repair techniques and continuous advances in biomedical devices and technology, it is difficult for practicing surgeons to stay abreast of new developments and incorporate these advances into their practice. Collaborative learning through video review can support continuous professional development and aid practicing surgeons in adopting new approaches and continually improving their own technical skills. Surgeons have limited time to invest in surgical quality improvement despite recognizing its importance. A critical gap in our current knowledge is the optimal approach to video-based collaborative learning. We therefore propose to compare the effectiveness of two approaches to video review and performance feedback: synchronous surgical coaching versus asynchronous feedback. This study will be performed in partnership with the Americas Hernia Society Quality Collaborative (AHSQC). Surgeons will be paired with a coach and will participate in collaborative review of ventral hernia repairs. Participants will be randomized to undergo in- person coaching or asynchronous feedback utilizing a web-based video platform (Surgus?) or will be assigned to a wait-list control group. All participants will submit 2 procedural videos pre- and post-intervention for self-assessment and blinded expert review utilizing a previously validated assessment instrument to measure technical skill. Our primary outcome is change in 30-day procedural outcomes, which are captured and risk adjusted in the AHSQC. Patients will also be followed for 2 years to assess long-term recurrence rates. Other secondary outcomes include intervention adherence, time spent in review, and the perceived value of the different approaches. These interventions will have immediate impact. Working with the AHSQC, we can improve quality and decrease costs for the 350,000 patients that require a ventral hernia repair annually. In addition, this will provide a new paradigm for surgical quality improvement and continuing professional development.

Public Health Relevance

Recent studies demonstrate the critical role of individual surgeon performance, including both the approach they take to an operation as well as their technical skill, in determining patient outcomes. Utilizing the rich data collected by the Americas Hernia Society Quality Collaborative (AHSQC) for its 200 members performing ventral hernia repair in the United States, we will examine the effectiveness of video-based collaborative learning to provide feedback and improve surgical performance and patient outcomes. We propose a prospective randomized trial comparing two interventions, live video-based surgical coaching and video-based feedback using time-stamped annotations that can be reviewed at a later time, to a wait-list control group drawn from the same cohort of surgeons. The results have the immediate potential to improve the quality of care for the 350,000 patients requiring ventral hernia repair each year, while also providing critical evidence to support a novel approach to surgical performance improvement more broadly.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Healthcare Patient Safety and Quality Improvement Research (HSQR)
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Gray, Darryl T
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University of Wisconsin Madison
Schools of Medicine
United States
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