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One-Stop Surgery: An Innovation to Limit Hospital Visits in ChildrenSource of Funding This research was supported by the Netherlands Organization for Health Research and Development (ZonMw), project number 852001903, and by Innovatiefonds Zorgverzekeraars (Health Insurers Innovation Fund), project number 3.555.
Introduction One-stop surgery (OSS) allows for same-day outpatient clinic visit, preoperative assessment, and surgical repair. This study aims to determine the efficiency, (cost-)effectiveness, and family satisfaction of one-stop inguinal hernia surgery compared with usual care.
Material and Methods Children (≥ 3 months) with inguinal hernia and American Society of Anesthesiologists (ASA) grades I–II, scheduled for OSS (intervention) or regular treatment (control) between March 1, 2017, and December 1, 2018, were eligible for inclusion. Exclusion criteria consisted of age less than 3 months and ASA grades III–IV. The primary outcome measure was treatment efficiency (i.e., total number of hospital visits and waiting time [days] between referral and surgery). Secondary outcome measures were the effectiveness in terms of complication and recurrence rate, and parent-reported satisfaction and cost-effectiveness using the Dutch Pediatric Quality of Life Healthcare Satisfaction and Institute for Medical Technology Assessment Productivity Cost Questionnaire.
Results Ninety-one (intervention: 54; control: 37) patients (56% boys) were included. Median (interquartile range) number of hospital visits was lower in the intervention group (1 vs 3; p < 0.001). All but one of the OSS patients (98%) were discharged home on the day of surgery. Postoperative complication (1.9% vs 2.7%; p = 0.787) and recurrence rates (0% vs 2.7%; p = 0.407) did not differ between the intervention and control patients. “General satisfaction,” “satisfaction with communication,” and “inclusion of family” were higher after OSS, while satisfaction about “information,” “technical skills,” and “emotional needs” were similar. Median (range) follow-up was 28 (15–36) months.
Conclusions Pediatric one-stop inguinal hernia repair seems to be an effective treatment strategy that limits the number of hospital visits and provides enhanced family satisfaction without compromising the quality of care.
KD, JD, and LvH conceived the study. AO, MvT, and LH made substantial contributions to the design of the work. KD, AO, JD, and LvH contributed toward the acquisition of data. KD, MvT, JT, and LH performed the analysis and interpretation of the data for the work. KD drafted the manuscript and JD, LJ, MvT, JT, LH, and LvH revised it critically for important intellectual content. All authors endorsed the data and conclusions, approved the final version to be published, and agreed to be held accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Institutional review board approval was obtained from the Medical Ethical Research Committee VU medical center (2017.124).
Extra data are available upon request by emailing the corresponding author.
Received: 28 March 2021
Accepted: 13 July 2021
02 December 2021 (online)
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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