Study About the Disappearance of Same-day Hernia Repair Method

A team of doctors led by Dr. Joanna Mills, a PhD candidate of the University of Sydney’s Northern Clinical School, have informed that same-day inguinal hernia repair was recognized as safe and effective 65 years ago. However, only 18 of the 526 surgeons paid for Medibank in 2015–2016 and 2016–2017 for patients who were discharged on the day allowed for five or more repair procedures (3%). Because this rate does not reflect international guidelines, the Royal Australian Surgeons' College (RACS) commissioned a literature review in 2017 with the input of medical professionals, recommending that 70%–80% of hernia hernias be performed on the same day procedures.

Although RACS has set a target of 70%–80% in 2017, Mills and colleagues analyzed and mentioned that less than a quarter of inguinal hernia repairs performed in Australia are same-day procedures, according to research published by the Australian Journal of Medicine.

“The same-day inguinal hernia repair rate rose from 22.4% in 2004–05 to 24.6% in 2017–18,” they reported. “By way of comparison, it increased in New Zealand from 42.7% to 46.5%, and in the United Kingdom from 45.8% to 67.8%.”

“We found that 23.1% of inguinal hernia repair procedures in Australia during 2000–19 were same-day procedures. The recent RACS 70–80% target was realised only for patients under 15 years of age who underwent unilateral repair.”

The benefits of same-day repair include out-of-pocket savings for patients, lower risk of procedure cancellation because of unavailable inpatient beds, lower risk of hospital infections, better patient-rated outcomes, better surgeon outcomes through standardized care, improved patient flow and resource allocation, and reduced cost to the health care system.

Of the 875,111 hospital admissions (783,623, 89.5% for male patients) for correcting inguinal hernia, 202,018 (23.1%; 95% confidence interval [CI], 23.0%–23.2%) were same-day procedures; the rates were higher for unilateral repair (24.4%; 95% CI, 24.3%–24.5%), for female patients (28.6%; 95% CI, 28.3%–28.9%), and for patients under 15 years of age (69.5%; 95% CI, 69.2%–69.9%). The same-day hernia repair rate increased from 20.0% (95% CI, 19.6%–20.3%) in 2000–01 to 25.1% (95% CI, 24.7%–25.5%) in 2018–2019; for unilateral repairs it increased from 20.1% (95% CI, 19.7%–20.5%) to 26.7% (95% CI, 26.2%–27.1%), but the ratio for bilateral repairs remained unchanged (2000–2001: 19.2%; 95% CI, 18.2%–20.2%; 2018–19: 19.6%; 95% CI, 18.8%–20.3%). The rate decreased with the patient's age and exceeded 70% for patients under 15 years of age who underwent unilateral repair.

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The same-day inguinal hernia repair rate rose from 22.4% (22.0%–22.8%) in 2004–2005 to 24.6% (24.2%–25.0%) in 2017–18. By way of comparison, it increased in New Zealand from 42.7% (41.6%–43.9%) to 46.5% (45.4%–47.6%), and in the United Kingdom from 45.8% (45.5%–46.2%) to 67.8% (67.5%–68.2%). The mean rate for this period was substantially lower in Australia (23.3%; 23.2%–23.4%) than in New Zealand (46.1%; 45.7%–46.4%) or the United Kingdom (58.9%; 58.8%–60.0%). In New Zealand, the same-day rate was lower in private (41.8%; 41.2%–42.3%) than in public hospitals (47.8%; 47.5%–48.2%).

It was found that 23.1% of inguinal hernia repair procedures in Australia in 2000–2019 were done in a same-day procedures. The latest RACS target of 70%–80% was realized only in patients under 15 years of age who were unilaterally repaired. Contrary to relatively stable, low rates in Australia, same-day rates were also higher in New Zealand and the United Kingdom. The rise in the United Kingdom is partly explained by the fact that National Health Service Hospitals have received £200–£250 (approximately $358–$447) for a same-day inguinal hernia repair procedure since the 1990s. Higher rates in New Zealand suggest that restrictions on same-day procedures may be related more to variations in surgical practice than to the health care system (public or private hospital).

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Most people who have a inguinal hernia repair in Australia may have multiple explanations for staying inpatient. The patient's report after same-day surgery is as good as the effects after staying overnight, but other factors may usually be a barrier to granting this option. Increasing the rates of same-day inguinal hernia repair involves the complex intervention of pre- and post-operative decisions by hospitals, surgeons and patients.

Mills and colleagues listed some perceived barriers to same-day repair as:

• Patient preferences for overnight stays;
• Surgeon preferences for overnight stays;
• Late scheduling on theatre lists;
• Distances between patient home and hospital;
• Inadequate outpatient or primary care support;
• Lack of adequate social support;
• Private hospital-insurer financial arrangements; and,
• Lack of access to an appropriate day surgery facility.

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“Patient-reported outcomes following same-day surgery are at least as good as those after overnight stays, but other factors may be barriers to routinely providing this option,” they concluded.

“Increasing same-day inguinal hernia repair rates will consequently involve a complex interplay of pre- and post-operative decisions by hospitals, surgeons, and patients.”

This study was supported by a Australian Government Research Training Program Scholarship and also formed a part of Joanna Mills’ doctoral research at the Sydney Medical School. The authors received a project grant funding from the HCF Research Foundation and they acknowledge the Australian Institute of Health and Welfare for providing the hospital admissions data.

The study was also granted exemption from formal ethics review by the University of Sydney Human Research Ethics Committee.

Source-Medindia