New research supports NHS teams to increase day case surgery rates for inguinal hernia repair

A largescale study into the reasons why patients listed for day case inguinal (groin) hernia repair surgery end up staying overnight in hospital has been carried out by the GIRFT team.

Published in the February 2024 issue of Hernia Journal, findings from the study – titled Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England – can support surgical teams to better identify patients suitable for day case inguinal hernia repair and plan discharge services more effectively, in turn freeing up beds for other patients and supporting the NHS drive to reduce waiting lists.

Day case inguinal hernia repair is now the default in many NHS hospital trusts in England. Although not suitable for everyone, the British Association of Day Surgery (BADS) has suggested that 80% of these procedures should be performed without the need for an overnight stay, allowing the patient to return to normal activity more quickly, reducing the risk of site-specific infection and thromboembolic complications, and making the surgery more cost-effective.

The new GIRFT study looked at data for all patients aged 17 or over in England undergoing their first elective inguinal hernia repair between April 2014 and March 2022 where the operation was planned as day case surgery. Of the 351,528 episodes, 45,305 (12.9%) ended up staying in hospital for at least one night – classed as a day case to inpatient conversion.

The study showed that these patients were generally older, had more comorbidities, were more likely to have bilateral surgery and more likely to be operated on by a surgeon who carried out the procedure less often (low annual volume). Post-procedural complications were also strongly associated with conversion.

This latest study follows GIRFT research published in 2023 on the safety of day case inguinal hernia, which showed that outcomes for day case and overnight stay elective primary inguinal hernia repair are similar, and concluded that reducing variation in day case rates across trusts in England could improve the patient experience and hospital productivity, and help reduce the backlog in elective surgery.

The GIRFT team behind both studies was the same:

  • James Joyner: GIRFT clinical fellow
  • Faraz Ayyaz: GIRFT clinical fellow
  • Mark Cheetham: GIRFT clinical lead for general surgery
  • Professor Tim Briggs: GIRFT chair and NHS England’s National Director for Clinical Improvement and Elective Recovery
  • William Gray: GIRFT’s academic content lead

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