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J Am Coll Surg. 2019 Sep;229(3):259-266. doi: 10.1016/j.jamcollsurg.2019.03.014. Epub 2019 May 2.

Development and Validation of the Ventral Hernia Repair Outcomes Reporting App for Clinician and Patient Engagement (ORACLE).

Author information

1
Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH.
2
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
3
Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: benjamin.poulose@osumc.edu.

Abstract

BACKGROUND:

Patient engagement is an increasingly important component of surgical decision making. Given the many factors associated with successful ventral hernia repair (VHR), we developed and validated the Outcomes Reporting App for Clinical and Patient Engagement (ORACLE) tool to help facilitate preoperative surgeon-patient discussions about VHR.

METHODS:

All patients undergoing elective, VHR with 30-day follow-up data available within the Americas Hernia Society Quality Collaborative were eligible for study inclusion. Using bootstrapping and bias-corrected calibration, predictive models were generated and validated for 5 quality measures after VHR, including postoperative wound events, estimated length of hospital stay, unplanned 30-day readmission to the hospital, and risk of hernia recurrence at 1 year postoperatively.

RESULTS:

A total of 10,690 patients met inclusion criteria. Based on comparison of the theoretical best to the observed calibration curves, the models for each of the 5 outcomes of interest have strong predictive strength as reflected in the Brier score for surgical site infection, surgical site occurrence requiring procedural intervention, and 30-day hospital readmission, the c-index for 1-year hernia recurrence and the R2 value for the model for predicted hospital length of stay.

CONCLUSIONS:

Using a national data set for development, ORACLE can be used to facilitate patient engagement, with the goal of tailoring interventions for VHR given each patient's unique factors. With ongoing data input into the Americas Hernia Society Quality Collaborative and a continuous re-evaluation of these risk models, it is our intention that this tool will serve as an up-to-date resource for hernia surgeons and ventral hernia patients.

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