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Archive May 2020 XXI, No. 5

The Right Way to Standardize Mesh Supplies

Consolidate your stock based on surgeon preference, cost and positive outcomes.

Mark Reiner

Mark Reiner, MD


IN GOOD HANDS Standardizing your facility's mesh supply should start by putting together a committee consisting of the surgeons who do the most hernia repairs.

On the surface, the decision to standardize your facility's mesh supplies is all about dollars and cents. After all, if you can switch from a couple dozen types of mesh to just two or three, surgeons will have fewer decisions to make and you can put together bigger orders with a single manufacturer who will reward you with a significant discount. Everybody wins, right? Not necessarily.

Surgeon preference should always be a key component of any decision to standardize mesh supplies. And rightly so. Skilled physicians who perform scores of hernia repairs are very particular about the mesh products they use. Surgeons with low recurrence and complication rates who are used to using a specific type of mesh will be loath to change the material they use unless there's some compelling evidence that doing so will result in better outcomes.

At the same time, cost is a huge consideration for facilities — particularly HOPDs and surgery centers that, in many cases, have been non-operational due to the COVID-19 pandemic. So how do you reconcile the benefits of consolidating and standardizing your mesh supplies with the need to provide your surgeons with the tools they need to perform safe and effective surgery? Let's break down that process.

1. Form a committee

The first step in standardizing your facility's mesh supply is to put together a committee of surgeons who do the most hernia repairs, the high-volume physicians who handle 75% to 80% of your facility's cases. After you get these individuals together, you can start to look at which mesh products to keep and which ones to cut from your facility's inventory. You should be able to cut your inventory to three or four different types of mesh after some thoughtful discussions with this committee.

2. Communicate the change

Of course, once you make that consolidation decision, there's a right way and a wrong way to communicate the news with those who didn't have a say in the process. Some facilities simply do it by decree: "We're using these mesh products, and we're not using anything else." I believe this is the wrong way to roll out the change. In my opinion, the proper way is to send the proposed change to any physician who performs hernia repairs and give them an opportunity to comment.

3. Listen to feedback

If a surgeon has a legitimate case for using a mesh that's not included in your proposed consolidation, you may want to consider adding a limited amount of a specific type of mesh to account for that exception. For instance, you might decide to make an exception for a surgeon who claims to need a biologic mesh that's been shown to reduce morbidities such as post-op wound infections and recurrence rates during infected cases.

In this case, your committee may decide to make an exception, or they may not. The important thing is allowing surgeons to provide their input on a policy change that may have major implications for them personally — and then actually listening to that feedback.

Surgeons with low recurrence and complication rates who are used to using a specific type of mesh will be loath to change.

If you're asking surgeons to change the way they operate, particularly surgeons with outstanding outcomes who have been using the same mesh product for years, they're bound to have some concerns and complaints. They will wonder whether different products will alter their techniques and cause a higher recurrence rate or a higher complication rate. These are legitimate concerns, and the right thing to do is hear them out.

If surgeons' preferred meshes will no longer be available, and they draw a line in the sand with respect to using the materials without a clear clinical reason for using them, let them know they'll have to take cases elsewhere if still want to operate with that particular mesh.

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