image004image002Surgery for a complex hernias is often an intricate repair and the success rate depends in large part on the overall health of the patient. The physicians at Premier Surgical Associates know that preparing patients to make health changes before surgery is crucial to a successful outcome, and offer a tool targeted specifically to complex hernia patients called CeDAR.

CeDAR is a free app that was created by Carolinas Surgical Innovation Group, LLC, in 2014, and two of Premier Surgical Associate’s physicians—Dr. Joel “Trey” Bradley and Dr. Kristopher Williams—were part of the team that developed the program. CeDAR, or Carolinas Equation for Determining Associated Risks, predicts the risks and financial costs of wound-related problems following complex hernia repair. The free app is available on Google Play or iTunes App.

CeDAR provides surgeons and patients with a powerful tool that can help predict individualized wound outcomes after abdominal hernia surgery. It also offers information on types of hernias and their treatments. Users simply answer eight questions about themselves, including height and weight. A percentage chance of developing specific postoperative complications requiring treatment is calculated, along with the corresponding cost of this treatment. These results can then be used to discuss a patient’s risk for wound problems after surgery and what changes they can make to improve the odds for a good result. CeDAR also includes information about what the following eight questions mean, and why each one is important:

  • Does the patient have uncontrolled diabetes?
  • Does the patient use tobacco products?
  • Has the patient had a previous hernia repair?
  • Will any other procedures cause entry into the GI tract or is there a stoma present in the patient?
  • Is there an active abdominal infection in the patient?
  • Is the patient to have concomitant skin and subcutaneous advancement flaps?
  • Is the patient to have concomitant component separation?
  • What is the patient’s height and weight?

As an example, if a patient answered “no” to the first 7 questions but the height and weight answers indicate obesity, CeDAR calculates a 13% risk of complications, resulting in in-hospital charges of nearly $3,000 and follow up charges of nearly $6,500 over and above national estimates for the average patient undergoing complex hernia repair.

After the physician and patient review the CeDAR results, they can then discuss ways to make changes that will help lower known risk factors such as smoking, obesity, uncontrolled diabetes, poor nutrition, and previous wound infections. Premier Surgical Associates has partnered with Fort Sanders Health & Fitness to offer N.E.W. University to our complex hernia patients. This Nutrition, Education, and Wellness program is designed to help them meet their pre-surgery weight, overall health, and nutrition goals and have a successful, lasting hernia repair.

Premier Surgical Associates is the largest surgical group in the Knoxville region, providing comprehensive surgical care, with referrals from across the entire East Tennessee Region. To learn more about preparing for complex hernia surgery, visit our Hernia Center website.