Expanding the Practice of Day-Case Inguinal, Femoral and Umbilical Hernia Repair: A Review of Patient and Procedural Factors Facilitating and Precluding Same-Day Discharge.

BACKGROUND: Despite the advantages of lower healthcare costs and decreased elective surgery wait times without compromise to patient outcome, rates of day-case hernia repairs remain much lower than the RACS target of 70%-80%. Certain patient cohorts are often unnecessarily excluded due to perceived risks.

OBJECTIVES: To review literature on patient and procedural factors influencing same-day discharge after inguinal, femoral, and umbilical hernia repairs, and to outline an evidence-based selection criteria and perioperative protocol to improve day-case rates.

METHODS: A systematic review of peer-reviewed English-language studies involving inguinal, umbilical, and femoral hernia repairs in patients over 18 years, in day and overnight case settings.

RESULTS: Patient factors facilitating same-day discharge are age under 65 years, ASA grades I-II, and uncomplicated hernia types. Selected patients aged over 65 or with ASA grades III-IV may be appropriate candidates and should not be excluded by default. Procedural factors facilitating same-day discharge include unilateral surgery, use of adjunctive local anaesthesia, and protocols to reduce risk of common postoperative complications. Logistical factors such as comprehensive discharge planning and strategic theatre scheduling can further increase the success of day-cases.

CONCLUSIONS: For appropriately selected patients, aged up to 80 years and ASA up to IV, day-case hernia repair can be a safe and effective alternative, offering comparable clinical outcomes and greater socioeconomic benefits. Comprehensive and holistic perioperative planning plays a crucial role to successfully expand day-case hernia repairs. Based on the results of this study, a patient selection criteria and perioperative protocol for day-case hernia repair are proposed.