One-Stop Surgery: An Innovation to Limit Hospital Visits in Children

Abstract

Introduction One-stop surgery (OSS) allows for same-day outpatient clinic visit, preoperative assessment, and surgical repair. This study aims to determine the efficiency, (cost-)effectiveness, and family satisfaction of one-stop inguinal hernia surgery compared with usual care. Material and Methods Children (≥ 3 months) with inguinal hernia and American Society of Anesthesiologists (ASA) grades I–II, scheduled for OSS (intervention) or regular treatment (control) between March 1, 2017, and December 1, 2018, were eligible for inclusion. Exclusion criteria consisted of age less than 3 months and ASA grades III–IV. The primary outcome measure was treatment efficiency (i.e., total number of hospital visits and waiting time [days] between referral and surgery). Secondary outcome measures were the effectiveness in terms of complication and recurrence rate, and parent-reported satisfaction and cost-effectiveness using the Dutch Pediatric Quality of Life Healthcare Satisfaction and Institute for Medical Technology Assessment Productivity Cost Questionnaire. Results Ninety-one (intervention: 54; control: 37) patients (56% boys) were included. Median (interquartile range) number of hospital visits was lower in the intervention group (1 vs 3; p < 0.001). All but one of the OSS patients (98%) were discharged home on the day of surgery. Postoperative complication (1.9% vs 2.7%; p = 0.787) and recurrence rates (0% vs 2.7%; p = 0.407) did not differ between the intervention and control patients. “General satisfaction,” “satisfaction with communication,” and “inclusion of family” were higher after OSS, while satisfaction about “information,” “technical skills,” and “emotional needs” were similar. Median (range) follow-up was 28 (15–36) months. Conclusions Pediatric one-stop inguinal hernia repair seems to be an effective treatment strategy that limits the number of hospital visits and provides enhanced family satisfaction without compromising the quality of care.

Reasons Behind Patients Defaulting from Elective Pediatric Urology Procedures at a Tertiary Private Teaching Hospital in South India

“…Nurse–patient preoperative call log is another innovative idea to reduce such cancellations. [ 7 ] Dreuning[ 8 ] suggested one-stop surgery as an innovative solution for inguinal herniotomy in children, where outpatient visits, preanesthetic consultation, and daycare procedures all were completed on the same day, limiting the turnaround time.…”

Age-specific and family-centered information modalities to prepare children at home for day-care surgery

“…Overall family satisfaction with information and communication and satisfaction with each of the information modalities individually was measured at the day of surgery using a modified and shortened version of the Dutch Pediatric Quality of Life (PedsQL)™ Healthcare Satisfaction Hematology/Oncology Specific Module questionnaire in one parent [21,22]. This modified questionnaire was developed by an expert panel consisting of pediatric surgeons, researchers and pediatric psychologists, and focused on satisfaction with information and communication in general, and satisfaction with information and communication via respectively use of coloring page, mobile app or video(s).…”