Anaesthetic preference and outcomes for elective inguinal hernia repair: a comparative analysis of public and private hospitals

Pandanaboyana, Sanjay; Marioud, Aseel; Woodward, Ann

doi:10.1007/s10029-012-1011-5

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…Sanjay et al [ 44 ] studied patient selection criteria, anesthetic preferences and outcomes of elective inguinal hernia repair in public and private sectors in England. The authors found that the mean wait time for patients undergoing hernia repair is 129 days in the public sector (range 16–379 days) and 15 days (range 8–61 days; p = 0.001) in the private sector.…”

Section: Resultsmentioning

confidence: 99%

Comparing public and private providers: a scoping review of hospital services in Europe

Tynkkynen

Vrangbæk

2018

BMC Health Serv Res

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BackgroundWhat is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research findings and to generate questions for further studies.MethodsThe review was based on a methodological approach inspired by the British EPPI-Centre’s methodology. This review was broader than review methodologies used by Cochrane and Campbell and included a wider range of methodological designs. The literature search was performed using PubMed, EconLit and Web of Science databases. The search was limited to papers published from 2006 to 2016. The initial searches resulted in 480 studies. The final sample was 24 papers. Of those, 17 discussed economic effects, and seven studies addressed quality.ResultsOur review of the 17 studies representing more than 5500 hospitals across Europe showed that public hospitals are most frequently reported as having the best economic performance compared to private not-for-profit (PNFP) and private for-profit (PFP) hospitals. PNFP hospitals are second, while PFP hospitals are least frequently reported as superior. However, a sizeable number of studies did not find significant differences. In terms of quality, the results are mixed, and it is not possible to draw clear conclusions about the superiority of an ownership type. A few studies analyzed patient selection. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals.ConclusionsThe paper points to shortcomings in the available studies and argues that future studies are needed to investigate the relationship between contextual circumstances and performance. A big weakness in many studies addressing economic effects is the failure to control for quality and other operational dimensions, which may have influenced the results. This weakness should also be addressed in future comparative studies.

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Section: Resultsmentioning

confidence: 99%

Comparing public and private providers: a scoping review of hospital services in Europe

Tynkkynen

Vrangbæk

2018

BMC Health Serv Res

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“… 32 Furthermore, Sanjay et al found no significant differences in postoperative complications following inguinal hernia repair in private versus public hospitals. 33 …”

Section: Discussionmentioning

confidence: 99%

Quality differences between private for-profit, private non-profit and public hospitals in Norway: a retrospective national register-based study of acute readmission rates following total hip and knee arthroplasties

Holom

Hagen

2017

BMJ Open

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ObjectivesTo compare the quality of care—using unplanned acute hospital readmissions as a quality measure—among patients treated at private for-profit hospitals (PFPs), private non-profit hospitals (PNPs) and public hospitals (PUBs) in Norway.DesignA retrospective comparative study using the Norwegian Patient Register. Readmissions were evaluated by logistic regressions both using adjustment for various patient-level and other covariates, and a two-stage model using distance as an instrumental variable.SettingThe Norwegian healthcare system.PopulationAll publicly financed patients having primary total hip (37 897 patients) or primary total knee arthroplasty (25 802 patients) at one of the three hospital types from 2009 to 2014.Primary outcome measure30-day unplanned acute hospital readmission rate.ResultsWe found highest readmission rates among PUBs and lowest among PFPs, for both procedures. However, the patients were on average more than 2 years younger at PFPs. PFPs also treated the least severe patients, while PUBs treated the most severe. Using adjustment for various patient-level and other covariates, compared to PUBs, both PFPs and PNPs had lower odds of readmission following both procedures. However, using the instrumental variable method, the only significant difference found was a lower odds of readmission at PNPs among hip patients when compared with PUBs. No patients in our data set were readmitted to PFPs, those originally treated at PFPs were readmitted to either PNPs or PUBs, and PUBs received most of the readmitted patients across hospital types.ConclusionsQuality differences between hospital types were small; however, PNPs had significantly lower readmission rates compared with PUBs among patients having total hip arthroplasty. PUBs received the larger part of the readmitted patients across hospital types and thus play an essential role in the care of more complex patients and for readmissions, regardless of any quality differences.

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“…Although LA is being more frequently used as a technique of choice, 1 GA is still the most applied anesthetic technique in most hospitals. 4,37 Because of the fact that every anesthetic technique has its benefits as well as its drawbacks, it is necessary for clinicians to make a proper decision in order to perform the best possible treatment.…”

Section: Agreements and Disagreements With Other Studies Or Reviewsmentioning

confidence: 99%

“…D espite the fact that open inguinal hernia repair is one of the most common surgical procedures performed with local anesthesia (LA), regional anesthesia (RA), and general anesthesia (GA) worldwide, there is still no general agreement regarding the best anesthetic technique with which it can be performed. Although LA is currently preferred to other types of anesthesia in specialized centers, 1 this practice is not reflected in community hospitals, where most of these procedures are performed. 2 Regarding some risks (referring to those with cardiorespiratory comorbidity), the deployment of up-to-date, short-acting anesthetic drugs enabled GA to be quite suitable for use in day surgery.…”

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confidence: 99%

Complications, Pain Control, and Patient Recovery After Local Versus General Anesthesia for Open Inguinal Hernia Repair in Adults—Systematic Review and Meta-analysis

Bakota

Kopljar

Šimić

et al. 2016

International Surgery

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The purpose of this systematic review is to provide an “up-to-date” evidence-based guideline and clarify the possible benefits as well as drawbacks of local anesthesia (LA) and general anesthesia (GA) in open inguinal hernia surgery in adults. Study method comprised randomized controlled trials. Primary outcome measures were complications, pain control, and patient recovery. Secondary outcome measures were patient satisfaction and hernia recurrence. A total of 14 randomized controlled trials contributed to the study. A total of 1677 patients were analyzed, with 953 in the LA group and 724 in the GA group. Complications were statistically less frequent in the LA group compared with the GA group [odds ratio (OR), 0.31; 95% confidence interval (95% CI), 0.15, 0.64). Supplemental intraoperative analgesia had a statistical significance in the LA group, with an OR of 28.93 (95% CI, 7.86, 106.47). Postoperative pain was statistically significantly lower in the LA group [standardized eman difference (SMD), −1.06; 95% CI, −1.64, −0.48)]. Length of stay was shorter for patients who underwent operation under LA compared with those receiving GA (OR, −1.21; 95% CI, −2.08, −0.33]). Time to full mobility was shorter in the LA group, without statistical significance (OR, 3.04; 95% CI, 0.19, 47.90), whereas measuring in SMD showed significance in comparison with GA (SMD, −1.74; 95% CI, −2.34, −1.14). Hernia recurrence was not noted. Patient satisfaction was greater in the LA group (SMD, 0.65; 95% CI, 0.15, 1.15). Compared with GA, LA showed superiority in terms of complications, postoperative pain, length of stay, time to full mobility, and patient satisfaction. Therefore, it appears to be a more appropriate anesthetic technique for open inguinal hernia repair in adults.

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Anaesthetic preference and outcomes for elective inguinal hernia repair: a comparative analysis of public and private hospitals

Abstract: Patients undergoing surgery in the private sector are younger, healthier, prefer general anaesthesia and have higher day case rates compared to public sector. The short- and long-term outcomes are similar between public and private sectors.

Cited by 11 publications

References 13 publications

Comparing public and private providers: a scoping review of hospital services in Europe

Comparing public and private providers: a scoping review of hospital services in Europe

Quality differences between private for-profit, private non-profit and public hospitals in Norway: a retrospective national register-based study of acute readmission rates following total hip and knee arthroplasties

Complications, Pain Control, and Patient Recovery After Local Versus General Anesthesia for Open Inguinal Hernia Repair in Adults—Systematic Review and Meta-analysis

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