Learn and share
We can continue learning at society meetings, courses and online
offerings. And you can learn if you happen to be in a venue where
there are other surgeons and experts. But again, there is — or should
be — a growing realization that we should all be collecting our own
data and our own outcomes, and using that data to help inform both
patients and our peers about opportunities for improvement. There
are a growing number of ways to do that. The American College of
Surgeons was one of the first, with the National Surgical Quality
Improvement Program (site.acsnsqip.org). There's also the American
Hernia Society Quality Collaborative (ahsqc.org). My company,
Surgical Momentum (surgicalmomentuminc.com), also provides quality
improvement and patient safety services.
We need to be looking at things from the standpoint of how we can
improve — perioperative pain management, pre-op preparation,
weight loss, smoking cessation, nutrition. What are the things that
give us the opportunity to have the best possible outcome?
Breakthroughs in pain
One of the biggest recent advances involves a couple of options for
long-acting local anesthetics. There are pain pumps that allow you to
implant a catheter and have local anesthetic delivered to the repair
site over a period of a few days. There are also long-acting local anes-
thetics that get released over time. Those options work really, really
well in some people, but not in everybody. What goes wrong?
Sometimes it's injection techniques. Sometimes it's catheter place-
ment. Sometimes there are patient factors. It might also be that a
given surgery turned out to be more extensive than expected and
involved other nerves outside of the anesthetized area.
In our practice, we now have some patients who wake up with no
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