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Inguinal hernia treatment in Switzerland: inpatient vs. outpatient setting — HerStAmb Study (prospective observational two-centre comparative study)

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A Correction to this article was published on 16 February 2023

This article has been updated

Abstract

Purpose

Since 01/2018, AVOS (ambulant vor stationär = outpatient to inpatient) regulation has been progressively implemented in hernia surgery in Switzerland. The aim of this prospective, observational, two-centre comparative study was to compare the outcome of outpatient and inpatient post-operative care in terms of AVOS by examining the re-admission rate, complication rate and quality of life in patients with primary unilateral inguinal hernia repair.

Methods

The study ran between 01/2019 and 04/2020 and included 237 patients with a primary unilateral inguinal hernia. Treatment setting was decided according to AVOS guidelines. Primary endpoint was re-admission rate within 6 weeks postoperatively. Secondary endpoints were the complication rate and patient outcome (quality of life) at 6 weeks follow-up postoperatively, as measured by the Short Form 36 Health Survey Questionnaire (SF-36).

Results

Complications occurred in 11 (14%) inpatient patients, but none required re-admitting for revision until follow-up at 6 weeks after discharge. In the outpatient group, there were 27 (17%) complications reported, while 6 (4%) of these patients crossed over to the inpatient group immediately after surgery. None of the other complications required re-admission until follow-up at 6 weeks. No significant relationship between treatment setting and number of complications/re-admission rate (p=0.458, p=0.061) was observed. The mean outcome (SF-36) between the treatment groups was not significantly different (p=0.16–0.856).

Conclusion

In terms of AVOS selection criteria in Switzerland, primary unilateral inguinal hernia can be safely treated in both treatment settings. Re-admission rates, complications and quality of life do not significantly differ. Day surgery in terms of AVOS might be as effective and efficient, both from the patient’s perspective and that of the institution.

Trial registration number

NCT05234242

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Change history

Abbreviations

ER:

Emergency Room

TEP:

Total Extraperitoneal Patch

TAPP:

Transabdominal Preperitoneal Patch

ASA:

American Society of Anaesthesiologists

AVOS:

Ambulant Vor Stationär = Outpatient to Inpatient

BMI:

Body Mass Index

DRG:

Diagnosis-Related Groups

SD:

Standard Deviation

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Authors and Affiliations

  1. Department of Surgery, Cantonal Hospital Schaffhausen, Geisbergstrasse 81, CH-8208, Schaffhausen, Switzerland

    Michal Ziga & Adrienne Imhof

  2. Faculty of Medicine, University of Zurich, Zurich, Switzerland

    Michal Ziga

  3. 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic

    Michal Ziga

  4. Department of Visceral-, Thoracic- and Vascular Surgery, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland

    Laurin Burla, Thomas Gürtler & Markus Weber

Authors
  1. Michal Ziga
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  2. Laurin Burla
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  3. Adrienne Imhof
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  4. Thomas Gürtler
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  5. Markus Weber
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Contributions

All authors contributed to the study conception and design. Study preparation and data collection were performed by Michal Ziga and Laurin Burla. Analysis and the first draft of the manuscript were written by Michal Ziga, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michal Ziga.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Zürich (Kantonale Ethikkomission Zürich, BASEC Nr. 2018-10832) and retrospectively registered in ClinicalTrial.com (NCT05234242).

Human and animal rights

All the procedures performed in the study were in accordance with the ethical standards of the institutional review board/international ethics committee for each centre and with the 1964 Helsinki Declaration and its later amendments.

Consent to participate and consent for publication

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Ziga, M., Burla, L., Imhof, A. et al. Inguinal hernia treatment in Switzerland: inpatient vs. outpatient setting — HerStAmb Study (prospective observational two-centre comparative study). Langenbecks Arch Surg 408, 14 (2023). https://doi.org/10.1007/s00423-023-02766-y

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