COST-ANALYSIS OF INPATIENT VERSUS OUTPATI ENT INGUINAL-HERNIA REPAIR

In Belgium 27,426 hernia repairs were performed in 1994 but only 1,451 (5.29 %) were done on ambulatory basis, whereas in the U.S. over 50 % of the yearly 600,000 hernia repairs are one day surgery procedures w ith interstate variation ranging: from 6 % to 89 %. The mean treatment cost of inguinal hernia repair (doctors fees + hotel cost) was 53,704 BEF for inpatients vs. 30,510 BEF (general anesthesia) and 27,501 BEF (local anesthesia) for outpatients. Rates of complication and recurre nce were not significantly different. This difference in total costs f or hospital admission are determined by the mean length of stay and by the individual forfeitairy day price according to the size of the hos pital. Also the use of routine diagnostic procedures (clinical chemist ry and medical imaging) - not necessarily essential for treatment - is higher at hospitalization. Even with 50 % of all hernia repairs carri ed out in the one day clinic, total cost savings for treatment will ha rdly exceed 20 % if the mean length of stay of the remaining inpatient s will not decrease simultaneously. Supplementary and dramatic cost re ductions however are possible by an earlier resumption of professional activities. The mean advised sick leave period of 4 weeks (+/-2) stil l depends on irrelevant parameters as tradition, patients' preferences , job characteristics and type of insurance. Total costs for work inca pacity add up to 2.5 billion BEF (vs. 1.4 billion BEF: Tor total treat ment costs) and can be cut by 50.18 % via a mean 2 weeks earlier retur n to work. Since open primary hernia repair under local anesthesia can be easily carried out on outpatients resuming unrestricted daily acti vities in less than 1 week. the laparoscopic procedure with general an esthesia, higher treatment cost (endoscopic material) and still debate d advantages in convalescence time and long-term outcome is not the go ld standard for uncomplicated inguinal hernia.