Shouldice Hernia Centre
Encyclopedia
Shouldice Hernia Centre is a hospital in Thornhill, Ontario
, Canada
, that is known for its specialization in external abdominal hernia
operations. Shouldice uses a natural tissue, tension free, technique developed during World War II
by Dr. Edward Earle Shouldice. Their ten full-time surgeons perform over 7500 hemiorrhapies each year. The facility, includes an administrative building which looks much like a southern mansion and a hospital wing designed specifically to meet the needs of hernia patients, is purposely comfortable, featuring a 23 acres (9.3 ha) property. Shouldice is a green facility with hot water and cooling systems powered by solar energy. The centre is owned by Shouldice Hospital Limited.
The facility was subject of a 1983 business case by the Harvard Business School
. Written by professor James Heskett, the report is currently the school's fourth-best-selling business case, selling nearly 260,000 copies. Twenty thousand students at 500 universities worldwide read about the centre annually, as part of their curriculum.
Shouldice launched a website in 1995. Over 300,000 visit the site each year; each year, over 2000 operations are scheduled online, and close to 10,000 emails requesting information are received.
Patients enter the hospital the day before surgery and are given a briefing about the procedures to be followed the next day. The night before the operation is also intended as an opportunity for patients to come to know each other: Shouldice encourages patients to work together to promote recovery.
Doctors from other institutes constitute a disproportionately higher percentage of patients ( doctors from the US needing surgery disproportionately go to Shouldice).
is used in most surgeries, instead of general anesthesia, as the second is unnecessary in most types of hernia surgeries, and the first is both safer and less expensive. General anesthesia is used when necessary in certain specially scheduled cases. The procedure most commonly used at Shouldice uses no artificial, surgical mesh.
Most surgeries at Shouldice involve re establishing natural anatomic integrity by sewing muscle layers together in an overlapping fashion to repair the hernia defect. The specific technique is often referred to as the Shouldice operation or the Canadian operation.Shouldice states that their complication rates (0.5%) are lower than rates achieved in general hospitals, described in The New England Journal of Medicine, April 2004 Vol. 350, No. 18, 33.4% for open mesh repairs and 39.0% for laparoscopic repairs of hernias.
The landscaped grounds, pool table, and putting green are all intended to encourage patients to be mobile following surgery: to take walks in the grounds and to stretch and bend while playing pool or practising putting. Similarly, there are no television sets or telephones in patients' rooms and beds have to be adjusted manually. A daily exercise program is also provided. Patient participation in their own recovery program is a corner stone of the Shouldice philosophy.
Patients are scheduled stay in the hospital for two days and three nights following surgery, although those who recover faster may leave earlier, if discharged by a surgeon after examination. In other hospitals the sort of low-risk patients that Shouldice operates on are sent home the same day without overnight hospitalization.
All rooms are double occupancy, and regularly flow through patients. The patient rooms have "low capital investment"—with no phone, television, and minimal medical equipment. Patients are essentially healthy people with a physical defect, which Shouldice cures. Therefore they are not treated as "sick" people but more as clean surgical patients who benefit from professional post operative and specialized care. The double occupancy rooms also provide income to cover costs not covered by the ministry of health in the global hospital budget. These mandatory charges are not covered by public health insurance. Shouldice is not, however, an example of the upper tier of two-tier health care
as no patient is turned away because of inability to pay.
Shouldice reports that fewer than 1% of patients have a recurrence after hernia repair. This compares to the 10-15% in normal hospitals. However, given that Shouldice does not perform surgery on patients weighing more than acceptable weight who are at greater risk of recurrence, meaningful comparison with other hospitals is not possible.
Studies carried out outside Shouldice generally show recurrence rates for "Shouldice repairs" (described above) which are higher than the recurrence rates reported by Shouldice, which demonstrates the importance of high volume experience in surgery. For example, a French study of 1,706 repairs performed using the Shouldice, Bassini's, and Cooper's ligament repairs found that Shouldice repairs had the lowest recurrence rate, but that the rate was 6.1% after 8.5 years. However, the surgeons performing the repairs in these studies are almost certainly less experienced with this type of repair than Shouldice surgeons. For example, in the French study, fewer repairs were performed over six years than would be performed in about three months at Shouldice.
Shouldice held annual patient reunions for 50 years, which one year attracted 1500 former patients. Reunions have been temporarily discontinued.
Thornhill, Ontario
Thornhill is a community in the Greater Toronto Area of Southern Ontario, Canada, located on the northern border of the city of Toronto. Once a municipal village, Thornhill is now a community and postal designation geographically split into two municipalities along Yonge Street, the city of...
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, that is known for its specialization in external abdominal hernia
Hernia
A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....
operations. Shouldice uses a natural tissue, tension free, technique developed during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
by Dr. Edward Earle Shouldice. Their ten full-time surgeons perform over 7500 hemiorrhapies each year. The facility, includes an administrative building which looks much like a southern mansion and a hospital wing designed specifically to meet the needs of hernia patients, is purposely comfortable, featuring a 23 acres (9.3 ha) property. Shouldice is a green facility with hot water and cooling systems powered by solar energy. The centre is owned by Shouldice Hospital Limited.
The facility was subject of a 1983 business case by the Harvard Business School
Harvard Business School
Harvard Business School is the graduate business school of Harvard University in Boston, Massachusetts, United States and is widely recognized as one of the top business schools in the world. The school offers the world's largest full-time MBA program, doctoral programs, and many executive...
. Written by professor James Heskett, the report is currently the school's fourth-best-selling business case, selling nearly 260,000 copies. Twenty thousand students at 500 universities worldwide read about the centre annually, as part of their curriculum.
Shouldice launched a website in 1995. Over 300,000 visit the site each year; each year, over 2000 operations are scheduled online, and close to 10,000 emails requesting information are received.
Pre-surgery
Shouldice requires patients to be at an acceptable weight appropriate to their height. Prospective patients who are overweight must bring down their weight to a level appropriate for the surgery. Shouldice states that it improves outcomes and has a full-time dietician on staff to help patients achieve their weight goals with guidance and special diets.Patients enter the hospital the day before surgery and are given a briefing about the procedures to be followed the next day. The night before the operation is also intended as an opportunity for patients to come to know each other: Shouldice encourages patients to work together to promote recovery.
Doctors from other institutes constitute a disproportionately higher percentage of patients ( doctors from the US needing surgery disproportionately go to Shouldice).
Surgery
Shouldice doctors normally take 35–40 min. Local anesthesiaLocal anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
is used in most surgeries, instead of general anesthesia, as the second is unnecessary in most types of hernia surgeries, and the first is both safer and less expensive. General anesthesia is used when necessary in certain specially scheduled cases. The procedure most commonly used at Shouldice uses no artificial, surgical mesh.
Most surgeries at Shouldice involve re establishing natural anatomic integrity by sewing muscle layers together in an overlapping fashion to repair the hernia defect. The specific technique is often referred to as the Shouldice operation or the Canadian operation.Shouldice states that their complication rates (0.5%) are lower than rates achieved in general hospitals, described in The New England Journal of Medicine, April 2004 Vol. 350, No. 18, 33.4% for open mesh repairs and 39.0% for laparoscopic repairs of hernias.
Recovery
Unlike many hospitals, Shouldice does not have a "fleet of wheelchairs and gurneys, armies of aides to push them, and banks of wide elevators." Instead, carpeted floors, low-rise stairs and beautiful grounds are available, encouraging activity. The Shouldice property comprises 23 acres (93,077.8 m²), with a greenhouse, putting green, sunrooms, pool table, stables, and dining hall. The hospital focuses on patient care, without compromising on speedy recovery.The landscaped grounds, pool table, and putting green are all intended to encourage patients to be mobile following surgery: to take walks in the grounds and to stretch and bend while playing pool or practising putting. Similarly, there are no television sets or telephones in patients' rooms and beds have to be adjusted manually. A daily exercise program is also provided. Patient participation in their own recovery program is a corner stone of the Shouldice philosophy.
Patients are scheduled stay in the hospital for two days and three nights following surgery, although those who recover faster may leave earlier, if discharged by a surgeon after examination. In other hospitals the sort of low-risk patients that Shouldice operates on are sent home the same day without overnight hospitalization.
All rooms are double occupancy, and regularly flow through patients. The patient rooms have "low capital investment"—with no phone, television, and minimal medical equipment. Patients are essentially healthy people with a physical defect, which Shouldice cures. Therefore they are not treated as "sick" people but more as clean surgical patients who benefit from professional post operative and specialized care. The double occupancy rooms also provide income to cover costs not covered by the ministry of health in the global hospital budget. These mandatory charges are not covered by public health insurance. Shouldice is not, however, an example of the upper tier of two-tier health care
Two-tier health care
Two-tier health care is a term used to describe a situation that arises when there is a basic health care system financed by government providing medically necessary but perhaps quite basic health care services, and a secondary tier of care for those with access to more funds who can purchase...
as no patient is turned away because of inability to pay.
Follow-up
Shouldice sends out a newsletter to all available patients every year. The newsletter includes a questionnaire for Shouldice's post-operative follow-up program. The program is considered the world's largest and longest-running follow-up program, having been in place for over 65 years with an average mailing of over 100.000 per year. The post-op is gradually transistioning to e-mail, as much as possible.Shouldice reports that fewer than 1% of patients have a recurrence after hernia repair. This compares to the 10-15% in normal hospitals. However, given that Shouldice does not perform surgery on patients weighing more than acceptable weight who are at greater risk of recurrence, meaningful comparison with other hospitals is not possible.
Studies carried out outside Shouldice generally show recurrence rates for "Shouldice repairs" (described above) which are higher than the recurrence rates reported by Shouldice, which demonstrates the importance of high volume experience in surgery. For example, a French study of 1,706 repairs performed using the Shouldice, Bassini's, and Cooper's ligament repairs found that Shouldice repairs had the lowest recurrence rate, but that the rate was 6.1% after 8.5 years. However, the surgeons performing the repairs in these studies are almost certainly less experienced with this type of repair than Shouldice surgeons. For example, in the French study, fewer repairs were performed over six years than would be performed in about three months at Shouldice.
Shouldice held annual patient reunions for 50 years, which one year attracted 1500 former patients. Reunions have been temporarily discontinued.
Primary staff
- Byrnes Shouldice, co-owner, president, chairman, former surgeon at the facility
- Germaine Urquhart, co-owner, vice president
- Daryl Urquhart, director of business development and grandson of the founder
- Shelley Shouldice, program coordinator, granddaughter of the founder
- Dr. Cassim T. Degani, MB, BS, MS, FRCSC, FACS, * Dr. Claude Joseph Burul, MD
- Dr. Ram K. Singal, MB, BS, FRCSC
- Dr. Earle Byrnes Shouldice, MD
- Dr. Michael A. Alexander, MB, BS, FRCSC, FACS Chief Surgeon, Shouldice Hospital
- Dr. Chin K. Chan, BS(Hon), MD, CM, CSPQ, DABS, FRCSC
- Dr. Richard T. Sang, MD
- Dr. Keith Slater, MD
- Dr. Rasheed. A. Affifi, MB, ChB, FRCSC
- Dr. N. Ross, MD
- Dr. Dr. Ash Maharaj, MD
- Dr. Dr. Robert Palmer, MD, FRCSC
- Dr. Alberto de la Rocha, MD, FRCSC
- Dr. Peter Kalman, MD, FRCSC, FACS
- Dr. Claude Burul, MD, FRCSC, Assistant Chief Surgeon, Shouldice Hospital
Notable patients
- Joe ClarkJoe ClarkCharles Joseph "Joe" Clark, is a Canadian statesman, businessman, and university professor, and former journalist and politician...
, 1980s - Jack LaytonJack LaytonJohn Gilbert "Jack" Layton, PC was a Canadian social democratic politician and the Leader of the Official Opposition. He was the leader of the New Democratic Party from 2003 to 2011, and previously sat on Toronto City Council, serving at times during that period as acting mayor and deputy mayor of...
, mid-1990s - Ralph NaderRalph NaderRalph Nader is an American political activist, as well as an author, lecturer, and attorney. Areas of particular concern to Nader include consumer protection, humanitarianism, environmentalism, and democratic government....
, mid-2000s
Trivia
- A season one episode of MonkMonk (TV series)Monk is an American comedy-drama detective mystery television series created by Andy Breckman and starring Tony Shalhoub as the titular character, Adrian Monk. It originally ran from 2002 to 2009 and is primarily a mystery series, although it has dark and comic touches.The series debuted on July...
featured the Shouldice grounds in exterior shots. - Shouldice was used as the White House in the movie: Murder at 1600Murder at 1600Murder at 1600 is a 1997 thriller film starring Wesley Snipes, Diane Lane, Dennis Miller, Ronny Cox, Daniel Benzali, and Alan Alda. The 1600 in the title refers to 1600 Pennsylvania Avenue, the address of the White House. The film is based on the novel Murder in the White House by Margaret Truman,...
. - A scene from Dawn of the Dead (2004 film)Dawn of the Dead (2004 film)Dawn of the Dead is a 2004 horror film directed by Zack Snyder in his directorial debut. It is a remake of George A. Romero's 1978 film of the same name and stars Sarah Polley, Ving Rhames, and Jake Weber. The film depict a handful of human survivors living in a Milwaukee, Wisconsin shopping mall...
was supposed to be filmed on the grounds in August 2003, but was cancelled because of poor weather conditions and the Northeast Blackout of 2003Northeast Blackout of 2003The Northeast blackout of 2003 was a widespread power outage that occurred throughout parts of the Northeastern and Midwestern United States and Ontario, Canada on Thursday, August 14, 2003, just before 4:10 p.m....
.
Further reading
- Bendavid R, The Shouldice Repair. Inguinal Hernia RepairInguinal hernia repairInguinal hernia repair refers to a surgical operation for the correction of an inguinal hernia.-Techniques:An operation in which the hernia sac is removed without any repair of the inguinal canal is described as a herniotomy...
, eds: Schumpelick V, Wantz GE. Basel, Karger, 1995, pp 122-134. - Bendavid R, E.E. Shouldice: A Biography. Problems in General Surgery, Vol 12, No 1, pp 1-5. Lippincott-Raven, Philadelphia, 1995.
- Bendavid R, The merits of the Shouldice repair. Problems in General Surgery, Vol 12, No 1, pp 105-109. Lippincott-Raven, Philadelphia, 1995.
- Bendavid R, Activity following herniorrhaphy. Inguinal Hernia Repair, eds: Schumpelick V, Wantz GE. Basel, Karger, 1995, pp 310-311.
- Bendavid R, Expectations of hernia surgery (inguinal and femoral). Principles and Practice of Surgical Laproscopes, ed. Simon Paterson-Brown and James Garden, W.B. Saunders Publishers, 1994 London, UK.
- Welsh D, Alexander M, The Shouldice Repair. Surgical Clinics of North America, Vol 73, No 3, June 1993, pp 451-469.