Single-incision laparoscopic treatment of pediatric IH has gained wide acceptance in the field of pediatric surgery after more than a decade of clinical practice [10]. LIHR not only reduces the postoperative recurrence rate [2, 11, 12], but also allows exploration for a contralateral IH and minimization of surgical related secondary damage [6, 13, 14]. Previously reported, the overall hernia recurrence rate of laparoscopic repair has been reduced to less than 1% [15], ranging from 0.13% to 0.42% [16, 17]. Shalaby et al., even reported that the postoperative recurrence rate was as low as 0% among 230 patients [18]. In our center, the recurrence rate of LIHR from 2016 to 2018 was 0.51% (6/1168). In the past 5 years (2018–2023), the recurrence rate of LIHR in our center has been reduced to 0.12% (16/13362), significantly lower than the reported data.

Day surgery has evolved along with the development of minimally invasive surgery, anesthesia, and anesthesia recovery techniques. After over 100 years of development, the proportion of day surgery has exceeded 60% in many European and American countries [19]. Our center begins exploring day surgery mode for pediatric OIHR since January 2016, with rapid development from 2018. Based on the OIHR experience in the day ward, we extended the day surgery mode to LIHR since 2020. This study aims to conduct a comprehensive analysis of the hospitalization efficiency and utilization of medical resources, clinical outcomes and safety, and patient satisfaction in the day ward.

By optimizing perioperative processes, including pre-completed preoperative examination, efficient patient’s transportation between recovery room and operating room, experienced surgical team and homogeneous anesthetic management, the day surgery mode greatly improves the hospitalization efficiency. More specifically, a single operating room in the day ward can perform a maximum of six LIHR surgeries in a morning (8:20 am–12:30 am) in our hospital, compared to three in the traditional ward. Discharge procedures for the first batch of patients are typically completed by 13:30–14:00 pm. Day surgery mode also increases use of medical resources, achieving high bed occupancy rates and reducing hospitalization cost. In our experience, bed occupancy rates in day ward can reach up to 150%, and the hospitalization costs were significantly lower than in traditional ward. The efficient day surgery mode is the first choice for most parents, especially those who are busy with work. And the excellent utilization rate of medical resources is a management model that more hospitals are willing to choose and vigorously develop.

In our study, the control of post-operative hernia recurrence rate in day ward matched that of the traditional ward, with no significant increase in the incidence of postoperative incision infections. The majority of pediatric patients are discharged successfully. with only a small number of patients experience delayed discharge due to postoperative nausea and vomiting (PONV), a main factor for delayed discharge in day surgeries [19, 20]. Among 8741 patients, three patients with severe PONV were transferred to traditional ward for conservative treatment, and the most severely affected patient was discharged after seven days of conservative treatment. Importantly, no anesthesia or surgical safety issues that endangered patient lives occurred, owing to strict three admission criteria (procedure, patient and surgeon) and three evaluation standards (preoperative, anesthesia and discharge assessments) [21]. Outstanding surgical and anesthesia safety, as well as a postoperative complication control rate that is not inferior to the traditional hospitalization mode, will inevitably make more parents willing and assured to choose the day surgery model.

The parent satisfaction score in day ward is higher than the traditional ward, especially in the aspects of surgical satisfaction, postoperative health guidance and hospitalization cost. One key factor is the standardized management of a single condition, allowing most anesthesiologists to use laryngeal mask airways, which facilitate faster intubation and extubation [22]. This is one of the important reasons for the high efficiency in day ward. Additionally, the fasting time for patients has been shorten by admitting patients in batches (the first batch at 7:30 am, the second batch at 10:00 am). Overall hospital stays in the day ward is controlled at approximately five hours, enhancing the patient experience by accelerating the surgical process through optimized perioperative management. Day surgery can be summarized in three words: safe, reliable and economical. This is also the main plus point for the high satisfaction of day surgery.

The present study has some limitations: retrospective nature, single-center, selection bias due to non-randomization. However, as the national clinical research center for child health, our patients come from all over the country, somewhat mitigating the selection bias and eliminating the impact of regional and demographic characteristics on the statistical data. In future research, we try to collaborate with regional pediatric medical centers to conduct multi-center studies, further evaluating whether the day surgery model can be further promoted in regional hospitals, particularly in developing countries where disparities in medical levels are notably prominent. Additionally, our center is trying to standardize and enhance the efficiency of this day surgery model and promote it across the entire surgical departments, including Oncology, Urology, Oral Surgery, Pediatric Gynecology, Cardiac Surgery, Thoracic Surgery, Otolaryngology, Orthopedics, Neurological Surgery, Ophthalmology, and Plastic Surgery. The procedures such as ligation of patent ductus arteriosus, excision of osteochondroma, excision of ovarian tumors, incision for hymenal obstruction, and adenoid or tonsil ablation are all relatively new practices. In 2024, a total of 6849 day surgeries have been completed across these departments, accounting for 22% of the total surgical volume at our hospital, significantly alleviating the pressure on hospital bed occupancy.