The benefits of a hernia service in a public hospital

Summary

A Hernia Service (HS) was commenced in Derriford Hospital, Plymouth, UK in May 1996 to improve patient outcome following a poor star rating for overall hospital performance in daycase hernia surgery. Between 1996 and December 1998, 576 patients, median age 65 years (range 24–88) with unilateral or bilateral inguinal hernias underwent surgical repair on the HS. During the same time period on the General Surgical Service (GSS) 1722 patients underwent surgical repair. On the HS, patients operated under local anaesthesia (LA) increased from 78.0 to 90.5%, and on the GSS use of LA increased from 7.6 to 22.4%. The percentage of daycases on the HS increased from 53.0 to 81.4% and on the GSS from 2.9 to 28.0%. The actual number of inpatient hospital days saved by the HS was 236 days in 1997 and 284 days in 1998. The potential saving was greater: in 1998 if the GSS daycase rate (28.0%) had been the same as the HS daycase rate (81.4%) 605 inpatient days would have been saved. A hernia satisfaction questionnaire was sent to a ran dom sample of 50 patients who had had their hernia repaired by the HS and 50 patients who had been treated by the GSS. HS patients experienced a mean pain score of 4,7 (range 1–10) compared to 5.7 (range 0–10) (p=0.07) for the GSS. Similarly, HS patients required less post-operative analgesia (mean 2.8 days compared to 5.9 days for the GSS group, p<0.01) and resumed normal activity at an earlier stage (mean 10.8 days compared to 17.6 days for the GSS patients, p<0.01). Instigation of a dedicated HS has improved patient outcome and substantially increased the use of local anaesthesia and the number of daycase hernia repairs on both the HS and the GSS, with substantial cost savings.