Abstract：
OBJECTIVE: Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery.
METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. 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.
RESULTS: A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%.
CONCLUSIONS: There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.
METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. 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.
RESULTS: A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%.
CONCLUSIONS: There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.
摘要：
目的：选择性原发性腹股沟疝修补术越来越多地作为日常手术进行。然而,一些计划进行日间手术的患者必须在医院至少住一个晚上。这项研究的目的是确定与择期腹股沟疝修补术从日间病例转换为住院管理相关的因素。
方法：这是对英格兰医院事件统计数据集的观察数据的探索性回顾性分析。所有年龄≥17岁的患者在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，计划为日间手术。感兴趣的暴露在入院当天（日间病例）或需要过夜。感兴趣的主要结果是过夜的30天紧急再入院。对于报告，提供者被汇总到综合护理委员会(ICB)级别。
结果：在8年的研究期间，共确定了351,528项计划的日间病例选择性原发性腹股沟疝修补术。其中,45,305（12.9％）在医院至少住了一个晚上，并被归类为日间病例到住院转换。转换为住院的患者年龄较大，有更多的合并症，并且更有可能进行双侧手术，并由低年产量的外科医生进行手术。术后并发症与转换密切相关。在英格兰的42个ICB中，模型调整后的转化率从3.3%到21.3%不等。
结论：在英格兰各ICB中，腹股沟疝修补术转换为住院率存在相当大的差异。我们的发现应有助于手术团队更好地识别适合日常腹股沟疝修补术的患者，并更有效地计划出院服务。这应该有助于减少转化率的变化。
方法：这是对英格兰医院事件统计数据集的观察数据的探索性回顾性分析。所有年龄≥17岁的患者在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，计划为日间手术。感兴趣的暴露在入院当天（日间病例）或需要过夜。感兴趣的主要结果是过夜的30天紧急再入院。对于报告，提供者被汇总到综合护理委员会(ICB)级别。
结果：在8年的研究期间，共确定了351,528项计划的日间病例选择性原发性腹股沟疝修补术。其中,45,305（12.9％）在医院至少住了一个晚上，并被归类为日间病例到住院转换。转换为住院的患者年龄较大，有更多的合并症，并且更有可能进行双侧手术，并由低年产量的外科医生进行手术。术后并发症与转换密切相关。在英格兰的42个ICB中，模型调整后的转化率从3.3%到21.3%不等。
结论：在英格兰各ICB中，腹股沟疝修补术转换为住院率存在相当大的差异。我们的发现应有助于手术团队更好地识别适合日常腹股沟疝修补术的患者，并更有效地计划出院服务。这应该有助于减少转化率的变化。
