Day-case inguinal hernia repairs: An analysis of same-day discharge rates and reasons for admission

Abstract

Introduction
The British Association of Day Case Surgery (BADS) suggest that 90% of inguinal hernia repairs (IHR) can be completed without an overnight stay in hospital.1 Between April and September 2022, our performance team reported only 79.0% of IHR’s were recorded as day-case. We completed an internal, retrospective audit to ascertain if the number of day-case IHR’s could be improved.
Methods
We examined admission notes for all 31 IHR cases which were not coded as day-case within this time frame. We wanted to determine if a planned admission, or same-day discharge, should have occurred.
Results
18 cases were admitted in line with BADS unplanned criteria. 2 patients were identified as missed candidates appropriate for planned overnight admission. 1 case had an unidentifiable cause of admission. 10 cases were found to be appropriate day-case surgeries, incorrectly identified by coding. The addition of these cases brings our proportion of elective IHR’s above 90%. It was concluded that a lack of clerical staff out of hours meant that day-case patients were not formally discharged on the IT system till the following morning. An evening shift for clerical staff has since been introduced to combat this.
Summary
Our audit suggests that our department completed >90% of IHR’s as day-case surgery, in line with BAD’s criteria, despite up to 13% of these cases not being captured appropriately by coding. The main barrier to correct coding is likely to be delayed discharge from the IT system.