Ambulatory hernia repair: a study of 1294 patients in a single institution

Abstract

Introduction ambulatory surgery is continuously expanding in global reach because of its several advantages. This study aimed to describe the experience of our department in outpatient hernia surgery, evaluate its feasibility and safety, and determine the predictive factors for failure of this surgery. Methods we conducted a monocentric retrospective cohort study on patients who had ambulatory groin hernia repair (GHR) and ventral hernia repair (VHR) in the general surgery department of the Habib Thameur Hospital in Tunis between January 1 st , 2008 and December 31 st , 2016. Clinicodemographic characteristics and outcomes were compared between the successful discharge and discharge failure groups. A p-value of ≤ 0.05 was considered significant. Results we collected data from the record of 1294 patients. One thousand and twenty patients had groin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3.0%) had unplanned admission (UA) and 7 patients (0.7%) had unplanned rehospitalization (UR). The morbidity rate was 2.4% while the mortality rate was 0%. On multivariate analysis, we did not identify any independent predictor of discharge failure in the GHR group. Two hundred and seventy-four patients underwent ventral hernia repair (VHR). The failure rate of ambulatory management of VHR was 5.5%: 11 patients (4.0%) had UA and 4 patients (1.5%) had UR. The morbidity rate was 3.6% and the mortality rate was zero. On multivariate analysis, we did not identify any variable predicting discharge failure. Conclusion our study data suggest that ambulatory hernia surgery is feasible and safe in well-selected patients. The development of this practice would allow for better management of eligible patients and would offer many economic and organizational advantages to healthcare structures.

Outpatient surgery and unplanned overnight admission in bilateral inguinal hernia repair: a population-based study

“…The rate of unplanned admissions in ambulatory inguinal hernia surgery varies considerably in the literature, ranging from 0-19% [14,15,30,[54][55][56][57]. In our study, we observed an unplanned overnight admission rate of 9.9%.…”

“…Our study found that age under 65 was independently associated with the choice of outpatient surgery. However, other studies have shown that older patients do not have higher complication rates than younger patients [8, 28, 29], suggesting that age should not be a contraindication for outpatient surgery [30,31]. Including elderly patients in outpatient surgery can increase utilization rates and provide them with the bene ts of a shorter hospital stay, such as reduced cognitive impairment [32].…”

Outpatient Surgery and Unplanned Overnight Admission in Bilateral Inguinal Hernia Repair: A Population-based Study

“…Our study found that age under 65 was independently associated with the choice of outpatient surgery. However, other studies have shown that older patients do not have higher complication rates than younger patients [ 8 , 28 , 29 ], suggesting that age should not be a contraindication for outpatient surgery [ 30 , 31 ]. Including elderly patients in outpatient surgery can increase utilization rates and provide them with the benefits of a shorter hospital stay, such as reduced cognitive impairment [ 32 ].…”

“…The rate of unplanned admissions in ambulatory inguinal hernia surgery varies considerably in the literature, ranging from 0 to 19% [ 14 , 15 , 30 , 54 – 57 ]. In our study, we observed an unplanned overnight admission rate of 9.9%.…”

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes

“…The most commonly used laparoscopic techniques for inguinal hernia repairs are transabdominal preperitoneal (TAPP) repair and total extraperitoneal (TEP) repair [ 7 ]. Moreover, in selected cases, hernia surgery may be performed safely on an ambulatory basis [ 8 , 9 ].…”