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Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data

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Abstract

Purpose

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.

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Data availability

This report does not contain patient identifiable data. Data in this report are anonymized. The underlying HES data cannot be made available directly by the authors as the data were obtained under licence/data sharing agreement from NHS Digital. HES data are available from NHS Digital upon application.

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Acknowledgements

We acknowledge NHS Digital for permission to use their data in this report. We also thank all staff within individual NHS trusts who collected and entered the data used in this study. The study protocol was not pre-registered.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK

    J. Joyner, F. M. Ayyaz, M. Cheetham, T. W. R. Briggs & W. K. Gray

  2. Department of General Surgery, Croydon Health Services NHS Trust, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK

    J. Joyner

  3. Manchester University NHS Foundation Trust, Manchester, UK

    F. M. Ayyaz

  4. Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK

    M. Cheetham

  5. Royal National Orthopaedic Hospital, London, UK

    T. W. R. Briggs

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  1. J. Joyner
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  3. M. Cheetham
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  4. T. W. R. Briggs
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  5. W. K. Gray
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Contributions

This study was designed and organized by JJ, WKG, AF and TWRB. Data cleaning and analysis was by WKG. Writing of the first draft was by JJ and WKG. All authors critically reviewed the manuscript and agreed to submission of the final draft.

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Correspondence to J. Joyner.

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Ethical approval was not sought for the present study because it did not directly involve human participants. This study was completed in accordance with the Helsinki Declaration as revised in 2013.

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Informed consent was not sought for the present study because it was an analysis of routine clinical data.

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Joyner, J., Ayyaz, F.M., Cheetham, M. et al. Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data. Hernia 28, 555–565 (2024). https://doi.org/10.1007/s10029-023-02949-y

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