Phone follow-up after inguinal hernia repair

Abstract

Background Typically, in-person follow-up in clinic is utilized after outpatient inguinal hernia repair. Studies have shown that phone follow-up may be successfully used for the detection of postoperative hernia recurrences. However, no studies have evaluated the detection rates of other postoperative complications, such as emergency department visits and readmissions, with the utilization of phone follow-up after inguinal hernia repair. The objective of our study was to investigate the safety of a phone follow-up care pathway following elective, outpatient inguinal hernia repair. Methods In this retrospective cohort study, adult patients who underwent elective, outpatient inguinal hernia repair between 2013 and 2019 at a large academic health system in the Midwest United States were identified from the electronic health record. Patients were categorized by type of postoperative follow-up: in-person or phone follow-up. Baseline demographics, operative, and postoperative data were compared between follow-up groups. Multivariable logistic regression was performed to investigate predictors of having any related emergency department (ED) visit/readmission/reoperation within 90 days. Results We included 2009 patients who underwent elective inguinal hernia repair during the study period. 321 patients had in-person follow-up only, while 1,688 patients had phone follow-up. There was a higher rate of laparoscopic repair in the phone follow-up group (85.4% vs. 53.0% for in-person follow-up). There were no differences in rates of related 90-day ED visits, readmissions, and reoperations between the phone and in-person follow-up groups. On multivariable logistic regression, receipt of phone follow-up was not a predictor of having 90-day ED visits, readmissions, or reoperations (OR 1.30, 95% CI [0.83, 2.05]). Conclusions Patients who underwent phone follow-up had similarly low rates of adverse outcomes to those with in-person follow-up. Phone follow-up protocols may be implemented as an alternative for patients and provide a means to decrease healthcare utilization following inguinal hernia repair. Keywords Hernia • inguinal • Telemedicine • Health services • Outcome assessment • health care Inguinal hernia repair is one of the most commonly performed general surgery procedures, with over 20 million repairs done worldwide annually [1, 2]. In the USA, over 700,000 inguinal hernia repairs are done each year [1]. With improvements in technology and technique, the safety profile of inguinal hernia repair has improved substantially, with mortality rates dropping to 0.2% [3]. The most common postoperative complications include surgical site complications, hernia recurrence, and chronic pain. However, these rates remain low overall. The rate of wound complications and surgical site infections are slightly higher and vary between 1 and 7% [3]. Hernia recurrences have been published to be between 1 and 3.5%, while the incidence of chronic pain is roughly 10% [3-5]. Inguinal hernia repair is typically done in an elective, outpatient set...

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