, Volume 22, Issue 6, pp 1023–1032 | Cite as

Quality measures in ventral hernia repair: a systematic review

  • B. J. SunEmail author
  • R. N. Kamal
  • G. K. Lee
  • R. S. Nazerali
Review Article



The US healthcare system is shifting towards reimbursement for quality over quantity of care. Quality measures are tied to financial incentives in these healthcare models. It is important that surgeons become familiar with quality measures addressing ventral hernia repair and understand candidate measures that may drive future quality measure development.

Study design

We performed a systematic review of society websites, quality measure databases, and the literature (Pubmed, Embase/Scopus, and Google Scholar) for quality measures addressing ventral hernia surgery. Clinical practice guidelines were included as candidate quality measures. All measures were categorized as structure, process or outcome according to Donabedian domains, as well as within the six National Quality Strategy (NQS) domains.


Thirty quality measures and candidate measures were identified. Eight candidate measures from the American Hernia Society addressed ventral hernia repair, and 22 quality measures in general surgery were also relevant to ventral hernia repair. Of the candidate measures, 6 (75%) were outcome and 2 (25%) were process measures. Of existing general surgery quality measures, 9 (41%) were outcome and 13 (59%) were process measures. No structural measures were identified. Overall, the majority of measures addressed NQS priorities of effective clinical care (33%) and patient safety (27%), while few addressed other domains.


Both the Donabedian domains of quality and NQS priorities were unequally represented in the current measures addressing ventral hernia repair. Recognizing and addressing the under-represented areas will provide a more balanced framework for developing quality measures and ensure that ventral hernia surgery is appropriately evaluated in value-based payment models.


Quality measures Ventral hernia Donabedian domains Merit-based incentive payment system Systematic review 


Compliance with ethical standards

Conflict of interest

BJS declares no conflict of interest. RNK declares no conflict of interest. GKL declares no conflict of interest. RSN declares no conflict of interest.

Ethical approval

Approval form the institutional review board was not required for this study.

Human and animal rights

This article does not contain any studies with human participants and animals performed by any of the authors.

Informed consent

For this literature review, formal consent is not required.


  1. 1.
    Centers for Medicare and Medicaid Services (2016) Quality Measures. Accessed 4 Sept 2016
  2. 2.
    Read the Affordable Care Act (2016) Accessed 4 Sept 2016
  3. 3.
    Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21th century. Iom. CrossRefGoogle Scholar
  4. 4.
    Centers for Medicare and Medicaid Services (2016) Value-based-programs Accessed 4 Sept 2016
  5. 5.
    Standards C, Services M (2015) National impact assessment of the centers for medicare and medicaid services (CMS) Quality Measures Report. 2015Google Scholar
  6. 6.
    Understanding the Merit-Based Incentive Payment System (MIPS) (2016) Accessed 4 Sept 2016
  7. 7.
    Page L (2016) Will you earn more or less money? Medscape Plastic Surgery. Accessed 27 July 2016
  8. 8.
    Centers for Medicare and Medicaid Services. Quality Payment Program (2017) Accessed 6 Jun 2017
  9. 9.
    Donabedian A (1997) The quality of care. How can it be assessed? JAMA 260(12):1743–1748. CrossRefGoogle Scholar
  10. 10.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34. CrossRefGoogle Scholar
  11. 11.
    Burns PB, Rohrich RJ, Chung KC (2011) The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 128(1):305–310. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Burwell SM (2015) Setting value-based payment goals—HHS efforts to improve US health care. N Engl J Med 372(10):897–899. CrossRefPubMedGoogle Scholar
  13. 13.
    Janis JE, OʼNeill AC, Ahmad J, Zhong T, Hofer SOP (2012) Acellular dermal matrices in abdominal wall reconstruction. Plast Reconstr Surg 130:183S–193S. CrossRefGoogle Scholar
  14. 14.
    Kissane NA, Itani KMF (2012) A Decade of ventral incisional hernia repairs with biologic acellular dermal matrix. Plast Reconstr Surg 130:194S–202S. CrossRefGoogle Scholar
  15. 15.
    Wong A, Lee S, Nathan NS et al. (2015) Postoperative prophylactic antibiotic use following ventral hernia repair with placement of surgical drains reduces postoperative surgical site infection rate. Plast Reconstr Surg. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sandvall BK, Suver DW, Said HK et al (2014) Comparison of synthetic and biologic mesh in ventral hernia repair using components separation technique. Ann Plast Surg. CrossRefGoogle Scholar
  17. 17.
    Fischer JP, Basta MN, Krishnan NM, Wink JD, Kovach SJ (2016) A cost-utility assessment of mesh selection in clean-contaminated ventral hernia repair. Plast Reconstr Surg 137(2):647–659. CrossRefPubMedGoogle Scholar
  18. 18.
    Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin N Am 93(5):1111–1133. CrossRefPubMedGoogle Scholar
  19. 19.
    De Vries Reilingh TS, Bodegom ME, Van Goor H, Hartman EHM, Van Der Wilt GJ, Bleichrodt RP (2007) Autologous tissue repair of large abdominal wall defects. Br J Surg 94(7):791–803. CrossRefPubMedGoogle Scholar
  20. 20.
    Sanchez-Manuel FJ, Seco-Gil JL (2012) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev.
  21. 21.
    Gurusamy KSAVB. (2013) Wound drains after incisional hernia repair (Review). Cochrane Database Syst Rev. (Copyright) CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • B. J. Sun
    • 1
    Email author
  • R. N. Kamal
    • 2
  • G. K. Lee
    • 3
  • R. S. Nazerali
    • 3
  1. 1.UC Irvine School of MedicineOrangeUSA
  2. 2.Department of Orthopedic SurgeryStanford University School of MedicineRedwood CityUSA
  3. 3.Department of Surgery-Plastic and Reconstructive SurgeryStanford University School of MedicinePalo AltoUSA

Personalised recommendations