OC-045 AMBULATORY HERNIA SURGERY IN PRIMARY CARE

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Abstract Background Approximately 100,000 hernia repairs are performed in the UK annually, the vast majority in hospital usually under general anaesthetic. Due to increased pressure on hospital facilities especially after the COVID-19 pandemic the waiting times for non-emergency surgery for benign conditions has increased. This study outlines the development and feasibility of a dedicated ambulatory primary care hernia service and examines the outcomes achieved between November 2018 and November 2021. Methods We prospectively analysed of records of 212 patients who underwent hernia repair in a primary care centre during the above period. Inclusion criteria were a) BMI<35 b) uncomplicated inguinal or umbilical hernia c) non recurrent hernia. The techniques used were Lichtenstein mesh repair for inguinal hernias and a primary sutured repair for ventral hernias. All procedures were performed as day-cases under local anaesthesia without sedation. All patients were telephoned by a healthcare professional a day after their operation. The primary outcomes of the study were length of stay, immediate complications and the secondary outcome was cost effectiveness. Results The median length of post-operative stay was 26 minutes. Complications were low and seen only in 5 patients and managed conservatively. The cost of hernia repair in primary care in UK is only £1012 when compared to £1800 in an NHS hospital. Conclusion Routine elective abdominal wall hernia repairs can be performed in a primary care setting, safely, with good clinical outcomes and clear economic benefits. However, this depends on the availability of surgeons and adequate funds to establish the service.

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