Getting It Right First Time Programme, NHS England, London, UK.
Croydon Health Services NHS Trust, Croydon, UK.
Hernia. 2023 Dec;27(6):1439-1449. doi: 10.1007/s10029-023-02893-x. Epub 2023 Oct 18.
Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, in England there is evidence of wide variation in day-case rates across hospitals. Reducing the extent of this variation has the potential to support more efficient use of resources (e.g., clinician time, hospital beds) and help the recovery of elective surgical activity following the COVID-19 pandemic. The aims of this study were to explore the extent of variation in day-case rates across healthcare providers in England and to evaluate the safety of day-case elective primary inguinal hernia repair surgery.
This was an exploratory, retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 were identified. The exposure of interest was day-case or in-patient stay, and the primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level.
A total of 413,059 elective primary inguinal hernia repairs were identified over the 8-year study period. Of these, 326,833 (79.1%) were day-case procedures. During the most recent financial year (2021-22), the highest day-case rate for an ICB was 93.8% and the lowest 66.1%. After adjusting for covariates, day-case surgery was associated with significantly lower rates of 30-day emergency readmission (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.58-0.64, p < 0.001) and for the secondary outcomes 180-day mortality and haemorrhage, infection and pain at 30-day post-discharge. Rates of 30-day emergency readmission were significantly lower in ICBs with high rates of day-case surgery (OR 0.84, 95% CI 0.74-0.96, p < 0.001) than in ICBs with low rates of day-case surgery, although rates of post-procedural haemorrhage within 30 days of discharge were significantly higher in trusts with high day-case rates (OR 1.20, 95% CI 1.04-1.40, p = 0.015).
For the outcomes studied, we found no consistent evidence that day-case elective inguinal hernia repair was unsafe for selected patients. Currently, there is substantial variation between ICBs in terms of delivering day-case surgery. Reducing this variability may help address the current pressures on the NHS in elective surgery.
择期腹股沟疝修补术越来越多地作为日间手术进行。然而，在英国，医院之间的日间手术率存在广泛差异。减少这种差异有可能支持更有效地利用资源（例如，临床医生的时间、医院床位），并帮助在 COVID-19 大流行后恢复择期手术活动。本研究的目的是探讨英国医疗服务提供者之间日间手术率的差异程度，并评估择期原发性腹股沟疝日间手术的安全性。
这是一项对英国医院病例统计数据集进行的探索性、回顾性观察数据分析。所有在 2014 年 4 月 1 日至 2022 年 3 月 31 日期间接受首次择期腹股沟疝修补术的年龄≥17 岁的患者均被纳入研究。感兴趣的暴露因素是日间手术或住院治疗，感兴趣的主要结局是 30 天内因急症需要再次住院且需过夜。为了便于报告，将提供者汇总到综合护理委员会（ICB）级别。
在 8 年的研究期间，共确定了 413059 例择期原发性腹股沟疝修补术。其中，326833 例（79.1%）为日间手术。在最近的财政年度（2021-22 年），ICB 的最高日间手术率为 93.8%，最低为 66.1%。调整了协变量后，日间手术与 30 天内急诊再入院的显著较低发生率相关（比值比（OR）0.61，95%置信区间（CI）0.58-0.64，p<0.001），并且在次要结局 180 天死亡率和术后 30 天的出血、感染和疼痛方面也有显著较低的发生率。日间手术率较高的 ICBs（OR 0.84，95%CI 0.74-0.96，p<0.001）与日间手术率较低的 ICBs相比，30 天内急诊再入院的发生率显著较低，尽管在日间手术率较高的信托机构中，出院后 30 天内出血的发生率显著较高（OR 1.20，95%CI 1.04-1.40，p=0.015）。
就研究的结果而言，我们没有发现有一致的证据表明，对于选定的患者，择期腹股沟疝修补术的日间手术不安全。目前，在提供日间手术方面，各 ICB 之间存在着显著的差异。减少这种差异可能有助于解决国民保健制度在择期手术方面的当前压力。
