Implementation of a Multidisciplinary Comprehensive Hernia Centre: Outcomes and Lessons Learnt

Abstract Background AWR is an elective procedure aimed at enhancing the quality of life for individuals dealing with complex hernias. Patients with obesity, a history of smoking, or diabetes tend to experience poorer outcomes in elective hernia repair. Pre-optimization before surgery becomes crucial to enhance patients’ surgical outcomes. Aim A multidisciplinary clinic and pre-optimization process have been implemented. This paper seeks to underscore the progress achieved through the adoption of a multidisciplinary approach, emphasizing the importance of a comprehensive strategy in managing these challenging cases. Methods Once patients get referred to the Comprehensive hernia centre, they are seen in clinic and discussed at the weekly Multidisciplinary Team (MDT) meeting and if appropriate they will be sign-posted into the pre-optimising process. A weekly Advanced Clinical Practitioner (ACP) telephone clinic has been established for the ongoing monitoring of patients requiring pre-optimization. Upon achieving their pre-optimization goals, patients are placed on the surgery list, and if required, their surgery is expedited appropriately. The paper includes a review of all patients seen in the MDT clinic at the Comprehensive Hernia Centre in 2023. Results 49 patients were listed for pre-optimization, with 8 needing smoking cessation, 45 requiring weight loss, and 13 needing diabetes control. Within the same period, 42 patients underwent surgery, with 22 requiring pre-optimization. Currently, 68 patients are undergoing post-surgery follow-up. Conclusion Our data shows that the majority of patients undergoing AWR require pre-optimisation, particularly regarding weight loss. By having a dedicated telephone clinic patient can be supported to achieve their targets prior to AWR surgery.