Appendix C. Detail on criteria for audit of the use of laparoscopic surgery for inguinal hernia repair | Laparoscopic surgery for inguinal hernia repair | Guidance

Possible objectives for an audit

An audit could be carried out on the appropriateness of the use of laparoscopic surgery for inguinal hernia to ensure the following.

Laparoscopic surgery is considered as one of the treatment options for the repair of inguinal hernia.
Individuals are fully informed of the risks and benefits of alternative procedures.
Surgeons carry out laparoscopic surgery for the repair of inguinal hernia only after receiving appropriate training and experience.

Possible patients to be included in the audit

An audit could be carried out on all people referred for repair of inguinal hernia in a reasonable time period for audit, for example, 6 months or 1 year.

Measures that could be used as a basis for an audit

The measures that could be used in an audit of laparoscopic surgery for inguinal hernia are as follows.

Criterion	Standard	Exception	Definition of terms
1. Laparoscopic surgery is considered as one of the treatment options for the repair of inguinal hernia	100% of the people referred for repair of inguinal hernia	None	Surgeons will need to agree locally on how consideration of laparoscopic surgery as a treatment option is recorded for audit purposes. In choosing between open and laparoscopic surgery, the following are considered: (a) the individual's suitability for general anaesthesia; (b) the nature of the presenting hernia; (c) the suitability of the particular hernia for laparoscopic or open approach; (d) the experience of the surgeon in open and laparoscopic procedures. 'Laparoscopic surgery' means the TEP or the TAPP procedure. 'Nature of the presenting hernia' means primary repair, recurrent hernia or bilateral hernias. 'Experience of the surgeon' refers to all three techniques, open surgery and the TEP or TAPP laparoscopic procedures.
2. The individual undergoing repair of inguinal hernia is fully informed of all the risks and benefits associated with open and laparoscopic surgery through the informed consent process	100% of people referred for repair of inguinal hernia	None	'Risks' include immediate serious complications, post-operative pain or numbness and long-term recurrence. 'Laparoscopic surgery' means either the TEP or the TAPP procedure. Clinicians will need to agree locally on how an individual is determined to be 'fully informed' of risks and benefits for audit purposes.
3. Laparoscopic repair of inguinal hernia is performed only by a surgeon who: a. has received appropriate training and b. regularly carries out the procedure	100% of people having laparoscopic repair of inguinal hernia	None	Clinicians will need to agree locally on what constitutes 'appropriate training' and how many procedures are needed in a given time period to count as 'regularly' carrying out the procedure.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed

x 100

Number of patients to whom the measure applies

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.