CC BY 4.0 · Eur J Pediatr Surg
DOI: 10.1055/s-0041-1740158
Original Article

One-Stop Surgery: An Innovation to Limit Hospital Visits in Children

1   Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
,
Joep P.M. Derikx
1   Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
,
Ayoub Ouali
1   Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
2   Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands
,
Liedewij M.J. Janssen
3   Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
,
Maurits W. van Tulder
4   Department of Health Sciences, Amsterdam Movement Science Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
5   Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
,
Jos W.R. Twisk
6   Department of Methodology and Applied Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
,
Lotte Haverman
7   Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
,
L.W. Ernest van Heurn
1   Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
› Author Affiliations
Source 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.

Abstract

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.

Authors' Contributions

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.


Ethics Approval

Institutional review board approval was obtained from the Medical Ethical Research Committee VU medical center (2017.124).


Data-Sharing Statement

Extra data are available upon request by emailing the corresponding author.


Competing Interests

None declared.


Supplementary Material



Publication History

Received: 28 March 2021

Accepted: 13 July 2021

Publication Date:
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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