By Christina Frangou
Las Vegas—It’s one of the oldest rituals between a surgeon and his or her patient: a preoperative discussion about a patient’s upcoming surgery. Now, there’s an app for that.
Hernia surgeons at Carolinas Medical Center have created an app that calculates a patient’s risk for postoperative wound complications and the associated costs from a ventral hernia repair.
“We can use this app to talk to our patients directly. We can show them how they are impacting their own outcomes,” said B. Todd Heniford, MD, director of the Carolinas Hernia Center, Charlotte, N.C., after announcing the app at the 2014 Annual Hernia Repair meeting.
The CeDAR app, short for the Carolinas Equation for Determining Associated Risks, predicts a patient’s risk for wound-related problems following ventral hernia repair.
The free app is intended for use by surgeons, patients or family members. Users answer eight questions about the patient, such as his or her height and weight, body mass index, smoking status and previous hernia repairs. Using the answers, the app calculates a percentage chance that the patient will develop postoperative complications requiring treatment.
The mathematical formula used to calculate the risk percentage is based on data from thousands of hernia patients around the world who are registered with the International Hernia Mesh Registry. More than 1 million data points were used to create the formula, Dr. Heniford said. Statisticians then confirmed the app’s accuracy and reliability.
CeDAR also provides an estimation of the corresponding cost of treatment.
Previous research from Carolinas Hernia Center has shown that the cost of a mesh infection after ventral hernia repair can reach six figures for a single patient’s care in the year after surgery. A patient who develops a mesh infection after surgery will incur inpatient hospital charges of $44,000 plus an additional $63,400 in follow-up costs over the next year, according to the analysis. Total expenses associated with a mesh infection can run as high as $107,000.
CeDAR is the second hernia-related app from the hernia team at Carolinas Medical Center. In 2012, the researchers released an app that predicts a patient’s risk for chronic discomfort one year after inguinal hernia repair.
William W. Hope, MD, assistant professor of surgery at the University of North Carolina, Wilmington, uses the inguinal hernia app frequently in his discussions with patients.
“It really opened my eyes. Before, I would tell a patient that you may have some chronic groin pain, but was quite surprised when I’d put their numbers in the app and it would say a 15% to 20% risk for chronic pain. When you use the data, you really can have an honest conversation with your patient.
“It’s an exciting use of technology and an exciting way to try to predict outcomes,” he said.
Dr. Hope said he expects the ventral hernia app will encourage patients take a bigger role in their health care. “We can show them the difference it will make if they lose 20 pounds or if they quit smoking. They’ll see a difference in infection and the massive amount of money that can be saved.”
Surgeons also can use the app in discussions with health insurance companies, Dr. Heniford said.
In North Carolina, insurance companies are putting pressure on surgeons to prove that they offer high-quality care without additional costs.
Two private health insurance companies, representing 95% of privately insured patients in the state, now tier surgeons based on their clinical quality outcomes, cost efficiency and accessibility. Patients must pay extra to receive treatment from a specialist not listed in the best tier.
But it’s not always clear to patients or insurance companies that some surgeons accrue higher outcomes and costs because they treat a higher-risk population, Dr. Heniford noted.
“We can use this app to speak to insurance companies. If an insurance company says, ‘Doctor, you’re a bad surgeon,’ you can demonstrate to them the kind of patients you are operating on.”
Dr. Heniford announced the app during a presentation on “big data” and its growing role in health care. Big data is a valuable health care tool that can be used to identify trends and correlations, to improve outcomes and to track surgeons’ performance, he said.
Surgeons need to take the lead on collecting their data to accurately reflect their patient population and their outcomes, Dr. Heniford said.
“If you as a surgeon have no data, [then] you have no fight against insurance companies.”
Surgeon-driven registries are taking off in hernia repair, he said. The International Hernia Mesh Registry started in 2007, and now includes data from more than 1,265 patients over a five-year period. More recently, American surgeons launched the Americas Hernia Society Quality Collaborative, which provides real-time outcomes data for surgeons.