Unplanned Inpatient Admission After Intended Outpatient Total Extraperitoneal Inguinal Hernia Repair: Precautionary Monitoring or Clinically Relevant Morbidity?

This is the authors' abstract. We don't add key points for this paper.

Background/Objectives: Unplanned inpatient admission after intended outpatient surgery is commonly regarded as failure of ambulatory management, although the clinical relevance of such admissions remains unclear. This study evaluated the causes, management, and short-term outcomes of unplanned inpatient admission after intended outpatient total extraperitoneal (TEP) inguinal hernia repair. Methods: This retrospective single-center study included all patients requiring unplanned inpatient admission after intended outpatient unilateral TEP repair between January 2022 and May 2025. Admission triggers, perioperative management, Clavien–Dindo complication severity, length of stay, need for invasive intervention, and 30-day outcomes were analyzed descriptively. Results: Among 153 intended outpatient TEP procedures, 45 patients (29.4%) required unplanned inpatient admission. The most frequent trigger was suspected intraoperative bleeding requiring observation (29/45, 64.4%), followed by technical or anatomical factors (6/45, 13.3%), cardiovascular events (4/45, 8.9%), other medical reasons (3/45, 6.7%), postoperative pain or nausea (2/45, 4.4%), and social or organizational reasons (1/45, 2.2%). Thirty-seven patients (82.2%) had no postoperative complication, six (13.3%) had Clavien–Dindo grade I–II complications, and two (4.4%) had grade III or higher complications requiring invasive intervention. Most patients were discharged on postoperative day 1 (35/45, 77.8%). No patient required blood transfusion, intensive care admission, or 30-day readmission. Conclusions: Unplanned inpatient admission occurred in 29.4% of intended outpatient TEP procedures, representing a relatively high admission rate for a planned outpatient pathway. Although most admissions were associated with precautionary monitoring rather than clinically relevant morbidity, invasive intervention was required in a small proportion of patients. The retrospective data do not allow individual admissions to be classified as avoidable; however, the findings suggest potential for pathway optimization through more standardized discharge assessment and formalized admission criteria. Prospective studies are required to determine whether such standardization can reduce unplanned inpatient stays while maintaining patient safety.