1
|
Hidalgo NJ, Guillaumes S, Llompart-Coll MM, González-Atienza P, Bachero I, Momblán D, Vidal Ó. Outpatient Surgery and Unplanned Overnight Admission in Bilateral Inguinal Hernia Repair: A Population-based Study. Langenbecks Arch Surg 2024; 409:165. [PMID: 38801551 PMCID: PMC11129998 DOI: 10.1007/s00423-024-03358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The use of outpatient surgery in inguinal hernia is heterogeneous despite clinical recommendations. This study aimed to analyze the utilization trend of outpatient surgery for bilateral inguinal hernia repair (BHIR) in Spain and identify the factors associated with outpatient surgery choice and unplanned overnight admission. METHODS A retrospective observational study of patients undergoing BIHR from 2016 to 2021 was conducted. The clinical-administrative database of the Spanish Ministry of Health RAE-CMBD was used. Patient characteristics undergoing outpatient and inpatient surgery were compared. A multivariable logistic regression analysis was performed to identify factors associated with outpatient surgery choice and unplanned overnight admission. RESULTS A total of 30,940 RHIBs were performed; 63% were inpatient surgery, and 37% were outpatient surgery. The rate of outpatient surgery increased from 30% in 2016 to 41% in 2021 (p < 0.001). Higher rates of outpatient surgery were observed across hospitals with a higher number of cases per year (p < 0.001). Factors associated with outpatient surgery choice were: age under 65 years (OR: 2.01, 95% CI: 1.92-2.11), hospital volume (OR: 1.59, 95% CI: 1.47-1.72), primary hernia (OR: 1.89, 95% CI: 1.71-2.08), and laparoscopic surgery (OR: 1.47, 95% CI: 1.39-1.56). Comorbidities were negatively associated with outpatient surgery. Open surgery was associated (OR: 1.26, 95% CI: 1.09-1.47) with unplanned overnight admission. CONCLUSIONS Outpatient surgery for BHIR has increased in recent years but is still low. Older age and comorbidities were associated with lower rates of outpatient surgery. However, the laparoscopic repair was associated with increased outpatient surgery and lower unplanned overnight admission.
Collapse
Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain
| | - M Magdalena Llompart-Coll
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Paula González-Atienza
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain
| | - Óscar Vidal
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
van Kesteren J, Meylahn-Jansen PJ, Conteh A, Lissenberg-Witte BI, van Duinen AJ, Ashley T, Bonjer HJ, Bolkan HA. Inguinal hernia surgery learning curves by associate clinicians. Surg Endosc 2023; 37:2085-2094. [PMID: 36303045 PMCID: PMC10017565 DOI: 10.1007/s00464-022-09726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Open inguinal hernia repair is the most commonly performed procedure in general surgery in sub-Saharan Africa, but data on its learning curve are lacking. This study evaluated the learning curve characteristics to improve surgical training and enable scaling up hernia surgery in low- and middle-income countries. METHODS Logbook data of associate clinicians enrolled in a surgical training program in Sierra Leone were collected and their first 55 hernia surgeries following the Bassini technique (herniorrhaphies) were analyzed in cohorts of five cases. Studied variables were gradient of decline of operating time, variation in operating time, and length of stay (LOS). Eleven subsequent cohorts of each five herniorrhaphies were investigated. RESULTS Seventy-five trainees enrolled in the training program between 2011 and 2020 were eligible for inclusion. Thirty-one (41.3%) performed the minimum of 55 herniorrhaphies, and had also complete personal logbook data. Mean operating times dropped from 79.6 (95% CI 75.3-84.0) to 48.6 (95% CI 44.3-52.9) minutes between the first and last cohort, while standard deviation in operating time nearly halved to 15.4 (95% CI 11.7-20.0) minutes, and LOS was shortened by 3 days (8.5 days, 95%CI 6.1-10.8 vs. 5.4 days, 95% 3.1-7.6). Operating times flattened after 31-35 cases which corresponded with 1.5 years of training. CONCLUSIONS The learning curve of inguinal hernia surgery for associate clinicians flattens after 31-35 procedures. Training programs can be tailored based on this finding. The recorded learning curve may serve as a baseline for future training techniques.
Collapse
Affiliation(s)
- Jurre van Kesteren
- Department of Surgery, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Pauline J Meylahn-Jansen
- Global Surgery Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Thomas Ashley
- CapaCare, Trondheim, Norway
- Kamakwie Wesleyan Hospital, Kamakwie, Sierra Leone
- Department of General Surgery, North Cumbria University Hospital, Carlisle, UK
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| |
Collapse
|
3
|
Analysis of the disease constituent ratio and prognosis of patients undergoing ambulatory surgery in oral and maxillofacial medicine: A monocentric retrospective analysis of 427 patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101266. [PMID: 35987501 DOI: 10.1016/j.jormas.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ambulatory surgery and single-visit surgery are becoming increasingly accepted and practiced. MATERIALS AND METHODS The clinical data of patients undergoing ambulatory surgery were collected, and information on their chief complaint and basic information was specifically included. Follow-up phone calls were conducted 1 and 3 days, 1 and 2 weeks, and 1 month after treatment. Information on their recovery and well-being was collected. RESULTS A total of 427 patients (males: 224, females: 203, average age: 23.07±11 years) were recruited for this study. A total of 43.55% of the patients chose ambulatory surgery. A total of 62.9% of them selected it for convenience, while 43.55% selected it for pain reduction. The top three diseases treated by ambulatory surgery were impacted teeth (56.7%), jaw cyst (14.75%) and supernumerary teeth (10.07%). Postoperative complications occurred in 248 of the 427 patients, with an incidence rate of 58.08%. The complication that occurred most frequently was postoperative pain (56.44%). Complications frequently occurred on Day 3 after the operation and resolved after 2 weeks. CONCLUSION After being diagnosed, ambulatory surgery is an effective mode of treatment for oral and maxillofacial diseases. Oral hygiene, professional postoperative follow-up visits and rigorous anesthesia evaluation are very important for ambulatory surgery for oral and maxillofacial diseases.
Collapse
|
4
|
Ziga M, Burla L, Imhof A, Gürtler T, Weber M. Inguinal hernia treatment in Switzerland: inpatient vs. outpatient setting - HerStAmb Study (prospective observational two-centre comparative study). Langenbecks Arch Surg 2023; 408:14. [PMID: 36622458 DOI: 10.1007/s00423-023-02766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/27/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Since 01/2018, AVOS (ambulant vor stationär = outpatient to inpatient) regulation has been progressively implemented in hernia surgery in Switzerland. The aim of this prospective, observational, two-centre comparative study was to compare the outcome of outpatient and inpatient post-operative care in terms of AVOS by examining the re-admission rate, complication rate and quality of life in patients with primary unilateral inguinal hernia repair. METHODS The study ran between 01/2019 and 04/2020 and included 237 patients with a primary unilateral inguinal hernia. Treatment setting was decided according to AVOS guidelines. Primary endpoint was re-admission rate within 6 weeks postoperatively. Secondary endpoints were the complication rate and patient outcome (quality of life) at 6 weeks follow-up postoperatively, as measured by the Short Form 36 Health Survey Questionnaire (SF-36). RESULTS Complications occurred in 11 (14%) inpatient patients, but none required re-admitting for revision until follow-up at 6 weeks after discharge. In the outpatient group, there were 27 (17%) complications reported, while 6 (4%) of these patients crossed over to the inpatient group immediately after surgery. None of the other complications required re-admission until follow-up at 6 weeks. No significant relationship between treatment setting and number of complications/re-admission rate (p=0.458, p=0.061) was observed. The mean outcome (SF-36) between the treatment groups was not significantly different (p=0.16-0.856). CONCLUSION In terms of AVOS selection criteria in Switzerland, primary unilateral inguinal hernia can be safely treated in both treatment settings. Re-admission rates, complications and quality of life do not significantly differ. Day surgery in terms of AVOS might be as effective and efficient, both from the patient's perspective and that of the institution. TRIAL REGISTRATION NUMBER NCT05234242.
Collapse
Affiliation(s)
- Michal Ziga
- Department of Surgery, Cantonal Hospital Schaffhausen, Geisbergstrasse 81, CH-8208, Schaffhausen, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Laurin Burla
- Department of Visceral-, Thoracic- and Vascular Surgery, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland
| | - Adrienne Imhof
- Department of Surgery, Cantonal Hospital Schaffhausen, Geisbergstrasse 81, CH-8208, Schaffhausen, Switzerland
| | - Thomas Gürtler
- Department of Visceral-, Thoracic- and Vascular Surgery, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland
| | - Markus Weber
- Department of Visceral-, Thoracic- and Vascular Surgery, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland
| |
Collapse
|
5
|
Guillaumes S, Hidalgo NJ, Bachero I, Juvany M. Outpatient inguinal hernia repair in Spain: a population-based study of 1,163,039 patients-clinical and socioeconomic factors associated with the choice of day surgery. Updates Surg 2023; 75:65-75. [PMID: 36287386 PMCID: PMC9834115 DOI: 10.1007/s13304-022-01407-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/18/2022] [Indexed: 01/16/2023]
Abstract
Reducing inpatient admissions and health care costs is a central aspiration of worldwide health systems. This study aimed to evaluate trends in outpatient surgery in inguinal hernia repair (IHR) and factors related to the outpatient setting in Spain. A retrospective cohort study (Record-Strobe compliant) of 1,163,039 patients who underwent IHR from January 2004 to December 2019 was conducted. Data were extracted from the public clinical administrative database CMBD ("Conjunto Mínimo Básico de Datos"). The primary outcome was the outpatient surgery rate. Univariate and multivariable analyses were performed to identify clinical and socioeconomic factors related to the outpatient setting. The overall proportion of outpatient repairs was 30.7% in 2004 and 54.2% in 2019 (p < 0.001). Treatment in a public hospital was the most remarkable factor associated with the likelihood of receiving an outpatient procedure (OR 3.408; p < 0.001). There were also significant differences favouring outpatient procedures for patients with public insurance (OR 2.351; p < 0.001), unilateral hernia (OR 2.903; p < 0.001), primary hernia (OR 1.937; p < 0.0005), age < 65 years (OR 1.747; p < 0.001) and open surgery (OR 1.610; p < 0.001). Only 9% of patients who pay for their intervention privately or 15% of those covered by private insurance were treated as outpatients. Spain has significantly increased the rate of outpatient IHR over the last 16 years. However, the figures obtained still leave a significant margin for improvement. Important questions about the acceptance of outpatient settings remain to be answered. Outpatient inguinal hernia repair in Spain. A population-based study of 1,163,039 patients: clinical and socioeconomic factors associated with the choice of day surgery.
Collapse
Affiliation(s)
- Salvador Guillaumes
- grid.410458.c0000 0000 9635 9413Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona (Seu Plató), C/Plató 21, 08006 Barcelona, Spain
| | - Nils Jimmy Hidalgo
- grid.410458.c0000 0000 9635 9413Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona (Seu Plató), C/Plató 21, 08006 Barcelona, Spain
| | - Irene Bachero
- grid.410458.c0000 0000 9635 9413Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona (Seu Plató), C/Plató 21, 08006 Barcelona, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital Universitari de Granollers, Granollers, Spain
| |
Collapse
|
6
|
Varying convalescence recommendations after inguinal hernia repair: a systematic scoping review. Hernia 2022; 26:1009-1021. [PMID: 35768670 DOI: 10.1007/s10029-022-02629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The most recent international guideline on inguinal hernia management recommends a short convalescence after repair. However, surgeons' recommendations may vary. The objective of this study was to give an overview of the current convalescence recommendations in the literature subdivided on the Lichtenstein and laparoscopic inguinal hernia repairs. METHODS In this systematic review, three databases were searched in August 2021 to identify studies on inguinal hernia repairs with a statement about postoperative convalescence recommendations. The outcome was convalescence recommendations subdivided on daily activities, light work, heavy lifting, and sport. RESULTS In total, 91 studies fulfilled the eligibility criteria, and 50 and 58 studies reported about convalescence recommendations after Lichtenstein and laparoscopic repairs, respectively. Patients were instructed with a wide range of convalescence recommendations. A total of 34 Lichtenstein studies and 35 laparoscopic studies recommended resumption of daily activities as soon as possible. Following Lichtenstein repairs, the patients were instructed to resume light work after median 0 days (interquartile range (IQR) 0-0), heavy lifting after 42 days (IQR 14-42), and sport after 7 days (IQR 0-29). Following laparoscopic procedures, the patients were instructed to resume light work after median 0 days (IQR 0-0), heavy lifting after 14 days (IQR 10-28), and sport after 12 days (IQR 7-23). CONCLUSION This study revealed a broad spectrum of convalescence recommendations depending on activity level following inguinal hernia repair, which likely reflects a lack of high-quality evidence within this field.
Collapse
|
7
|
van Hessen C, Roos M, Frederix G, Verleisdonk EJ, Clevers GJ, Davids P, Burgmans J. One-stop routing for surgical interventions: a cost-analysis of endoscopic groin repair. Surg Endosc 2019; 34:1968-1977. [PMID: 31321538 DOI: 10.1007/s00464-019-06971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/01/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Single-visit (SV) totally extraperitoneal (TEP) inguinal hernia repair is an efficient service without impairment of safety or complication rate. Data on the economic impact of this approach are rare. The aim of this study was to compare the costs between the SV TEP and the regular TEP in an employed healthy population from a hospital and societal point of view. METHODS Retrospectively collected hospital costs and prospectively collected societal costs were obtained from patients treated between July 2016 and January 2018. Outcome measures consisted of all documented institutional care, productivity loss and medical consumption. RESULTS For analysing the hospital costs, a total of 116 SV patients were matched to 116 regular patients. The hospital costs of a mean SV patient were €1148.78 compared to €1242.84 for a regular patient, with a mean difference of €94.06. Prospective analyses of 50 SV patients and 50 regular patients demonstrated higher societal costs for a mean regular patient (€2188.33) compared to a mean SV patient (€1621.44). The mean total cost difference between a SV TEP repair and a regular TEP repair equalled €660.95 corresponding to a 19.3% decrease in costs. CONCLUSIONS This comprehensive cost-analysis showed that in an employed, healthy population, the SV TEP repair outprices the regular TEP repair, with savings of €660.95 per patient, reflecting a 19.3% decrease in costs. This routing is mainly interesting from a societal point of view as the difference is mainly impacted by a decrease in societal costs.
Collapse
Affiliation(s)
- Coen van Hessen
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands. .,Department of Surgery, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
| | - Marleen Roos
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands
| | - Geert Frederix
- Julius Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Egbert Jan Verleisdonk
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands
| | - Geert Jan Clevers
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands
| | - Paul Davids
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands
| | - Josephina Burgmans
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands
| |
Collapse
|
8
|
Cunningham ME, Justus CA, Milewicz AL, Wortley MG, Denner FR, Hollier LH, Nuchtern JG, Wesson DE, Fraser CD, Shah SR. Single-visit surgery: An evaluation from an institutional perspective. J Pediatr Surg 2019; 54:1108-1111. [PMID: 30905415 DOI: 10.1016/j.jpedsurg.2019.02.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Elective ambulatory surgical care traditionally involves three independent visits. Single-Visit Surgery (SVS) is an alternative surgical model that consolidates care into one visit. Evaluation of the effect of this novel program on hospital operations is limited. The objective of this study was to analyze SVS from an institutional perspective. METHODS We retrospectively reviewed patients scheduled for SVS at a freestanding children's hospital between January 2016 and August 2017. Data collected included clinic "no show" rates, operating room (OR) utilization, reimbursement rates, and postoperative visits. RESULTS There were 89 patients scheduled for SVS, of which 63% (n=56) were male, and the median age was 6 years [IQR, 4-9]. The SVS clinic "no show" rate was 2% (n=2) compared to the pediatric surgery clinic "no show" rate of 11% (p=0.01). The SVS OR block utilization rate was 90%. Payment was received from third-party payors for 92% of consultations and 100% of operative procedures without securing prior authorization. Postoperatively 25% (n=17) of patients presented to clinic for follow-up, and one child presented to the emergency department for vomiting. There were no hospital admissions. CONCLUSION Single-Visit Surgery is an alternative model of ambulatory surgical care that improves institutional efficiency while also enhancing the patient experience. TYPE OF STUDY Retrospective cohort review LEVEL OF EVIDENCE: III.
Collapse
Affiliation(s)
| | | | | | | | | | - Larry H Hollier
- Texas Children's Hospital, Department of Surgery, Houston, TX
| | - Jed G Nuchtern
- Texas Children's Hospital, Department of Surgery, Houston, TX
| | - David E Wesson
- Texas Children's Hospital, Department of Surgery, Houston, TX
| | | | - Sohail R Shah
- Texas Children's Hospital, Department of Surgery, Houston, TX.
| |
Collapse
|
9
|
Scarfe A, Duncan J, Ma N, Cameron A, Rankin D, Karatassas A, Fletcher D, Watters D, Maddern G. Day case hernia repair: weak evidence or practice gap? ANZ J Surg 2018; 88:547-553. [PMID: 29573102 DOI: 10.1111/ans.14302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/10/2017] [Accepted: 10/01/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Analysis of a private insurer's administrative data set revealed significant variation in the length of hospital stay following hernia surgery. OBJECTIVES This review examined factors influencing the performance of day surgery for inguinal, femoral and umbilical hernia repair in adults. DATA SOURCES A systematic literature search was conducted in the PubMed, Embase and Cochrane Library databases to identify studies and clinical practice guidelines (CPGs) comparing same day hernia surgery to surgery followed by an overnight stay. REVIEW METHODS Screening of studies by abstract and full text was completed by a single researcher and checked by a second. Studies were selected for inclusion based on a step-wise approach across three phases. RESULTS Limited evidence from one systematic review, and three case series studies including 3213 patients found that same day hernia surgery was as safe and effective as an overnight stay. All identified CPGs recommended a same day procedure for most patients. Two case series studies reported that 3-8% of patients were ineligible for day procedures due to medical reasons; however, the characteristics of patients, in general, which are not suitable, have not been adequately investigated. CONCLUSIONS Day surgery for groin hernia repair is safe and effective for most patients. However, evidence-based support is only one of many factors that may contribute to the uptake of day surgery in Australia. There is an opportunity for key stakeholders across the private healthcare system to deliver an equally effective but more sustainable and affordable hernia care by increasing the day surgery rates.
Collapse
Affiliation(s)
- Anje Scarfe
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Joanna Duncan
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Ning Ma
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Alun Cameron
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - David Rankin
- Provider Networks and Integrated Care, Medibank Private, Melbourne, Victoria, Australia
| | - Alex Karatassas
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Fletcher
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Watters
- Department of Surgery, Geelong Hospital and Deakin University, Geelong, Victoria, Australia
| | - Guy Maddern
- Department of Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
10
|
Carty NJ, Curtis NJ, Ranaboldo CJ. Single hospital visit day case laparoscopic hernia repair without prior outpatient consultation is safe and acceptable to patients. Surg Endosc 2016; 30:5565-5571. [PMID: 27129559 DOI: 10.1007/s00464-016-4929-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND For some common conditions, pre-operative clinic visits are often of little value to the patient or surgeon with transfer to the waiting list being predictable. In response to local patient feedback, we introduced a single hospital visit laparoscopic hernia surgery pathway with focus on informed consent, patient-reported outcomes and post-operative interaction with primary care services. METHODS A single hospital visit service for elective hernia repairs was created. Patients were not excluded on age, BMI or co-morbidity. Following referral, patients were telephoned by a surgeon. If considered appropriate, a symptom assessment tool, procedure information and consent form were sent. All patients were operated without attending clinic or pre-operative assessment. Surgeon-led telephone follow-up was made at either 2 or 7 days post-operatively and patient satisfaction assessed at 3 months. RESULTS A total of 517 patients were referred for single-stop surgery between 2012 and 2015. Median age was 58 (range 20-92), 91 % were male, and mean BMI was 25.6 (17.4-52.0). No patient refused the single-visit pathway. Single-stop patients had higher knowledge questionnaire scores (mean 16 vs. 10, p = 0.01) than patients who had attended clinic. Nine (1.7 %) were requested to attend clinic to confirm diagnosis, and three (0.8 %) were cancelled by their surgeon on the operative day. A total of 393 hernia repairs (331 TEP, 63 open) were performed under general anaesthetic. 92 % were discharged on day zero. Telephone follow-up day two rather than seven decreased attendance to primary care services (25 % vs. 57 %, p = 0.001). At 3 months, 95 % were satisfied and symptom scores were reduced (median 5-0, p < 0.0001). CONCLUSION Single-visit surgery appears to extend the patient benefits of laparoscopy by reducing hospital visits without compromising safety. Single hospital visit hernia surgery for unselected primary care referrals is possible and acceptable to patients.
Collapse
Affiliation(s)
- N J Carty
- Department of Surgery, Salisbury District Hospital, Odstock Road, Salisbury, SP2 8BJ, UK.
| | - N J Curtis
- Department of Surgery, Salisbury District Hospital, Odstock Road, Salisbury, SP2 8BJ, UK
| | - C J Ranaboldo
- Department of Surgery, Salisbury District Hospital, Odstock Road, Salisbury, SP2 8BJ, UK
| |
Collapse
|
11
|
Bökkerink WJ, Akkersdijk WL, Koning GG. Comment to "One-stop endoscopic hernia surgery: efficient and satisfactory" Voorbrood et al. Hernia 19:395-400. Hernia 2016; 20:339-40. [PMID: 26847764 DOI: 10.1007/s10029-016-1461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- W J Bökkerink
- Department of Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - W L Akkersdijk
- Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
| | - G G Koning
- Department of Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
12
|
One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey. PLASTIC SURGERY INTERNATIONAL 2015; 2015:747961. [PMID: 26236502 PMCID: PMC4506812 DOI: 10.1155/2015/747961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 11/17/2022]
Abstract
Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.
Collapse
|