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

Dr Liberty-Isabelle Todd, Miss Heather Davis, Mr Christopher Briggs
University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom


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.