One-day surgery. Treatment for anterior abdominal wall hernias in day patient department of a clinic

Background. Today it is necessary to reduce the burden on surgical departments of hospitals by limiting the number of minor surgeries and expanding the possibilities of outpatient surgery which can reduce the stay in a medical institution to just a few hours. Objective. To substantiate the effectiveness of surgical treatment of hernias of the anterior abdominal wall in the day patient department of a clinic during 3 years in order to confirm its clinical and economical effectiveness in combination with the accelerated recovery program. Methods. The one-day surgery program has been implemented at the Rostov Clinical Hospital since 2019, together with the accelerated recovery program at the day patient department of the clinic. The day patient department has 10 beds, an operating room with anesthesia equipment and an anesthesiologist. Patients receive treatment in accordance with the multimodal accelerated recovery program (ARP). 154 hernioplasty surgeries were performed in the day patient department by the program during 3 years. After surgery, patients were placed in the day patient department wards. A few hours later, after full activation, they were allowed to go home without being accompanied by a medical worker. The patients were surveyed to clarify their satisfaction with the program on a 5-point scale. Results. With equal costs for medicines and examination, due to the cost-intensity ratio, the treatment of patients according to the CSG "Hernia surgery, adults (level 3)" was more cost-effective in the day patient department of the clinic (ds32.005 - 3.24) than in the in-patient department (st32.015 - 1.78). The satisfaction with the one-day surgery program was high (4.76), confirming its effectiveness. Conclusion. The one-day surgery program in combination with the accelerated recovery program expanded the use of the day patient department for the surgical treatment for anterior abdominal wall hernias, being as effective as standard treatment in the hospital.