Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project

Abstract

Introduction There is a need for hernia centers and specialist hernia surgeons because of the increasing complexity of hernia surgery procedures due to new techniques, more difficult cases and a tailored approach with an increasing public awareness demanding optimal treatment results. Therefore, the requirements for accredited/certified hernia centers and specialist hernia surgeons should be formulated by the international and national hernia societies, while taking account of the respective health care systems. Methods The European Hernia Society (EHS) has appointed a working group composed of 18 hernia experts from all regions of Europe (ACCESS Group—Hernia Accreditation and Certification of Centers and Surgeons—Working Group) to formulate scientifically based requirements for hernia centers and specialist hernia surgeons while taking into consideration different health care systems. A consensus was reached on the key questions by means of a meeting, a telephone conference and the exchange of contributions. The requirements formulated below were deemed implementable by all participating hernia experts in their respective countries. Results The ACCESS Group suggests for an adequately equipped hernia center the following requirements: (a) to be accredited/certified by a national or international hernia society, (b) to perform a higher case volume in all types of hernia surgery compared to an average general surgery department in their country, (c) to be staffed by experienced hernia surgeons who are beyond the learning curve for all types of hernia surgery recommended in the guidelines and are responsible for education and training of hernia surgery in their department, (d) to treat hernia patients according to the current guidelines and scientific recommendations, (e) to document each case prospectively in a registry or quality assurance database (f) to perform follow-up for comparison of their own results with benchmark data for continuous improvement of their treatment results and ensuring contribution to research in hernia treatment. To become a specialist hernia surgeon, the ACCESS Group suggests a general surgeon to master the learning curve of all open and laparo-endoscopic hernia procedures recommended in the guidelines, perform a high caseload and additionally to implement and fulfill the other requirements for a hernia center. Conclusion Based on the above requirements formulated by the European Hernia Society for accredited/certified hernia centers and hernia specialist surgeons, the national and international hernia societies can now develop their own programs, while taking account of their specific health care systems.

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

“…Fifty to 100 procedures with a proportion of 25 laparo-endoscopic repairs appears inadequate to technically overcome any learning curve associated with a specified surgical technique (TEP or TAPP [19]. Therefore, the ACCESS Group advises that all general surgeons should be better trained in order to become proficient in abdominal wall surgery by first of all overcoming the learning curve of both open and laparo-endoscopic hernia procedures as recommended by the current guidelines with direct and guided supervision [1].…”

“…In summary, the Access Group recommends the implementation for a recognized and credited specialist in abdominal wall surgery. As experience in hernia surgery is difficult to measure [76], patient characteristics and outcomes should be followed by a registry [1].…”

“…The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recommends unequivocally a need for the training of specialist hernia surgeons [1]. The most important argument for this recommendation is the increasing complexity of abdominal wall surgery due to new techniques, more difficult cases, a recognized tailored approach and an increasing public awareness which demands nothing short of optimal treatment results [1]. The rising complexity of abdominal wall surgery has led to the international hernia societies publishing several guidelines [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Litigation claims following laparoscopic and open inguinal hernia repairs

“…Furthermore, it is not possible to link volume of cases to individual surgeons or unit. The European Hernia Society (EHS) recommended that hernia repairs should be carried out by hernia specialist surgeons working in accredited/certified hernia centres with a high case volume [27]. It would be interesting to see the impact of high-volume specialist surgery on litigation.…”

Establishing a center of excellence in abdominal wall reconstruction

“…The European Hernia Society has also developed an expert consensus comprising 18 surgeons across Europe to form the ACCESS Group (Hernia Accreditation and Certification of Centers and Surgeons -Working Group) to formulate scientifically based requirements for hernia centers and hernia specialists [38] . They propose that an adequately prepared hernia center will have the following components: accredited/ certified by a national or international hernia society, perform higher case volume hernia surgery compared to average, experienced surgeons beyond their learning curve, evidence-based clinical treatment, document outcomes in hernia registry or database, and perform follow-up comparisons of outcomes with benchmark data for continual improvement [38] . These recommended requirements have been put forth so that healthcare systems can develop their own programs, while taking into account specific healthcare system constraints [38] .…”