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

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.

Keywords

child - inguinal hernia - hernia repair - one-stop surgery

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.

Publikationsverlauf

Eingereicht: 28. März 2021

Angenommen: 13. Juli 2021

Artikel online veröffentlicht:
02. Dezember 2021

• References

• 1 Morini F, Dreuning KMA, Janssen Lok MJH. et al. Surgical management of pediatric inguinal hernia: a systematic review and guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee. Eur J Pediatr Surg 2021; ••• DOI: 10.1055/s-0040-1721420.
• 2 Tagge EP, Hebra A, Overdyk F. et al. One-stop surgery: evolving approach to pediatric outpatient surgery. J Pediatr Surg 1999; 34 (01) 129-132
• 3 Cunningham ME, Justus CA, Milewicz AL. et al. Single-visit surgery: an evaluation from an institutional perspective. J Pediatr Surg 2019; 54 (06) 1108-1111
• 4 Barnett SJ, Frischer JS, Gaskey JA, Ryckman FC, von Allmen D. Pediatric hernia repair: 1-stop shopping. J Pediatr Surg 2012; 47 (01) 213-216
• 5 Criss CN, Brown J, Gish JS, Gadepalli SK, Hirschl RB. Clinic-day surgery for children: a patient and staff perspective. Pediatr Surg Int 2018; 34 (07) 755-761
• 6 Olson JK, Deming LA, King DR. et al. Single visit surgery for pediatric ambulatory surgical procedures: a satisfaction and cost analysis. J Pediatr Surg 2017; 53 (01) 81-85
• 7 The Royal Dutch Medical Assciation (RDMA). RDMA-guideline. Informed consent in medical treatment of minors [in Dutch: KNMG-wegwijzer Toestemming en informatie bij behandeling van minderjarigen]. 2019
• 8 Varni JW, Quiggins DJL, Ayala GX. Development of the Pediatric Hematology/Oncology Parent Satisfaction survey. Child Health Care 2000; 29: 243-255 https://eprovide.mapi-trust.org/instruments/pediatric-quality-of-life-inventory-healthcare-satisfaction-hematology-oncology-specific-module
• 9 Hakkaart-van RoijenL, van der Linden N, Bouwmans CAM, Kanters TA, Tan SS. Costing manual: methodology of costing research and reference prices for economic evaluations in healthcare [in Dutch: Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg]. Zorginstituut Ned 2016; 1-73