Abstract

Background and objectives. The Estonian Health Insurance Fund has introduced an indicator according to which at least 70%
of inguinal hernia repairs should take place as procedures of outpatient surgery. At Tartu University Hospital, the proportion of outpatient surgery in inguinal herniotomy has been significantly lower than the set standard, being 39-49% in 2017-2019.
The purpose of this study was to find out whether it would be potentially possible to increase the proportion of outpatient surgery in inguinal hernia repair at Tartu University Hospital.
Study design. This is a retrospective study. Based on the data collected, an anesthesiologist and a general surgeon assessed the
option of performing the operation in an outpatient or inpatient setting.
Results. In the study years 2017-2019, 339 adults were operated electively as inpatients for inguinal hernia, accounting for
52.8% of all elective inguinal hernia repairs at Tartu University Hospital. The opinion of the anesthesiologist and the general
surgeon regarding outpatient vs inpatient surgery coincided in 86.1% of the cases. Evaluation of the anesthesiologist and the
general surgeon, considering outpatient surgery, coincided in 138 of the cases, which would have increased the proportion
of outpatient surgery in inguinal hernia repair to 68.7% during the period of our study. If the patient had chronic heart insufficiency, chronic obstructive pulmonary disease or chronic renal insufficiency, then it was more likely that both the
anesthesiologist and the general surgeon would have referred the patient for inpatient treatment. This is tantamount to the
situation where the patient’s medications include cardiac drugs, anticoagulants or antiplatelet drugs.
Conclusions. The results of this study indicate that it is possible to increase the proportion of outpatient surgery in inguinal hernia repair at Tartu University Hospital. Further research should be conducted to find out the reasons for the present low percentage of outpatient inguinal hernia repair. Furthermore, it is necessary to specify the exact criteria for patient selection for out- or inpatient inguinal hernioplasty.