Ambulatory inguinal hernia repair in Portugal - a multicenter prospective cohort study

Ambulatory surgery is the recommended approach for elective inguinal hernia repair for most people. However, the relative use of this procedure in Portugal and its related outcomes are unknown. We aimed to assess complication rates in patients undergoing ambulatory and inpatient surgery. Prospective multicentric cohort study included consecutive patients undergoing elective inguinal hernia repair in mainland Portugal (October-December 2019). The primary outcome was the post-operative complication rate (any Clavien-Dindo grade) among patients undergoing ambulatory and inpatient surgery. A logistic regression analysis was performed to adjust for patient and disease-related co-variables. Eight hundred twenty-eight patients (89.1% of males) were included from thirty-three hospitals, of which seven hundred sixteen (86.4%) had unilateral hernias. Four hundred thirty-three (52.2%) were operated on as day cases and three hundred ninety-five (47.7%) with overnight stays. There were no significant differences in post-operative complication rate between patients undergoing ambulatory and overnight stay surgery, both in unadjusted (9.9% vs. 11.1%; p = 0.650) and adjusted (odds ratio: 1.08 [95% CI 0.66-1.76]) analyses. Ambulatory surgery was only performed in half of the patients, although this procedure is not associated with an increased risk of complications. These results should promote the expanded use of ambulatory surgery in patients eligible for elective inguinal hernia repair.