Specialised Hernia Clinic and Dedicated Hubs Is It the Route Towards Optimisation: Day Case Inguinal Hernia Performance a 12 Month Service Evaluation

Abstract Introduction Guy’s and St Thomas’ Trust currently performs 88% of inguinal hernia repairs as day case procedures, above The British Association of Day Surgery target of 80%. A specialised hernia clinic was set up in our trust in May 2021, to better identify patients suitable for High Volume Low Capacity (HVLC) Hubs. These are new surgical hubs introduced following COVID to help with the backlog and provide ring fenced beds for low complexity procedures. The clinic also provides standardisation of patient information and literature provision together with enhanced training opportunities for junior surgeons. Method A retrospective review of elective day case inguinal and femoral hernia repairs from 01 Jan 2022 to 31 Dec 2022. We primarily assessed unexpected admissions (UA) and the effects of a specialised clinic on service provision and outcomes. Results An UA was required in 20 cases; the majority being discharged within 24 hours. The most common reason was due to post-operative acute urinary retention (AUR). Other reasons included monitoring as per request of Anaesthetics, comorbidities, post-operative pain and social reasons. We also found the specialised hernia clinic identified the majority of patients expected to require an admission post-operatively. Conclusions The most common reason for an UA was AUR and the most adjustable were social admissions, indicating pathway implementations should involve a retention pathway and home alone surgery, respectively. Furthermore, a specialised hernia clinic was able to better identify cases suitable for HVLC Hubs, therefore could streamline the experience for both patients and surgeons in training.