Study findings support the drive to increase day case surgery for inguinal hernia repair

Reducing the variation in day case rates for the repair of inguinal (groin) hernias across trusts in England can help address the current NHS pressures on elective surgery, according to a new study.

A team of GIRFT researchers examined day case rates across providers, as well as evaluating the safety of day case surgery, for a new study recently published in Hernia Journal entitled Day-case and in-patient elective inguinal hernia repair surgery across England: an observational study of variation and outcomes.

While primary inguinal hernia repair is now widely performed as a day case procedure for suitable patients, the variation in rates across Integrated Care Boards (ICBs) during 2021-22 was significant, ranging from around 94% of cases in the best-performing ICB down to 66%. More than 40% of ICBs had day case rates below the target of 80% set by the British Association of Day Surgery (BADS). Day case rates also varied across the seven NHS regions.

Rates of 30-day emergency readmission were significantly lower in ICBs with high rates of day case surgery. Although rates of post-procedural haemorrhage within 30 days of discharge were higher in trusts with high rates of day case surgery, there was no difference in rates of repeat surgery, mortality, post-procedural infection, post-procedural pain, or venous thromboembolism between the two groups.

To support with elective recovery, GIRFT is working with trusts and systems to maximise the effectiveness and throughput of their surgical theatres and has joined with BADS to identify procedures which should be conducted as day case as the default – inguinal hernia repair is among them. The benefits of day surgery for patients include a more rapid return to normal activities, a reduction in site-specific infection and a reduction of thromboembolic complications.

The new study provides evidence that outcomes for day case and overnight stay elective primary inguinal hernia repair are similar, supporting the BADS and GIRFT recommendation that such procedures should be conducted as day-case as the default. It concludes that day case should be utilised for all suitable patients, to improve patient experience and hospital productivity, and to help reduce the post-COVID-19 backlog in elective surgery.

The study was carried out by:

  • 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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