ObjectiveTo identify the influencing factors for 24 hours delayed discharge after inguinal hernia surgery and to construct a predictive model for assessing postoperative 24 hours delayed discharge. MethodsThis study adopted a retrospective approach to collect the clinical data of 1 499 postoperative inguinal hernia patients who were admitted to the Department of General Surgery, Shaanxi Provincial People’s Hospital from Jan. 2021 to Dec. 2023. Multivariate logistic regression analyses was performed, and a nomogram was developed based on the multivariate results. Model discrimination was evaluated using receiver operating characteristic curve, calibration was assessed using calibration plots, and clinical utility was examined using decision curve analysis (DCA). ResultsThe results of the comprehensive multivariate regression analysis clearly indicated that open surgery [OR=4.085, P＜0.001], neuraxial anesthesia [OR=13.275, P＜0.001], general anesthesia [OR=6.414, P＜0.001], operation time>90 min [OR=1.575, P=0.008], intraoperative blood loss>5 mL [OR=1.530, P=0.003], medical adhesive-assisted closure [OR=0.683, P=0.038], postoperative pain score≥3 [OR=9.907, P＜0.001], postoperative nausea and vomiting [OR=2.553, P＜0.001], postoperative urinary retention [OR=4.534, P=0.001], postoperative scrotal edema [OR=2.105, P=0.001] were influencing factors for 24 hours delayed discharge after inguinal hernia surgery. A nomogram was constructed accordingly to the results and the area under the curve of the prediction model was 0.823 [95%CI (0.802, 0.844)]. The calibration curve demonstrated that the predictive model had good predictive performance (χ2=10.167, P=0.253). The DCA demonstrated that the predictive model yielded the maximum net benefit when the threshold probability ranged from 10% to 80%. ConclusionsFor patients undergoing inguinal hernia repair, open surgery, neuraxial and general anesthesia, operation time>90 min, intraoperative blood loss>5 mL, non-medical adhesive-assisted closure, postoperative pain score≥3, as well as the occurrence of postoperative nausea and vomiting, urinary retention and scrotal edema are the risk factors of delayed discharge beyond 24 hours. Based on these findings, targeted perioperative assessment, management and preventive interventions can be implemented in clinical practice, which not only facilitates early postoperative discharge for inguinal hernia patients, but also indirectly provides a reference for the admission criteria of ambulatory surgery patients.
