To explore the perceived importance of essential Value-Based Healthcare (VBHC) and patient-centred care elements within operational military healthcare among wounded service members (WSM), military surgeons (MS) and medical commanders, and to identify preconditions that enable the delivery of patient-centred care and relevant medical outcomes during military operations.

A two-round Delphi study was conducted following the Accurate Consensus Reporting Document guideline. An initial list of 17 preconditions was developed through a narrative-style literature review and expert-panel discussion. Preconditions were rated on a four-point Likert scale (‘not important’ to ‘very important’) to reach consensus on ‘military-oriented’ preconditions for patient-centred trauma care.

An in-person expert-panel meeting and subsequent online Delphi surveys conducted between March 2020 and September 2022.

The expert panel consisted of Dutch military healthcare leaders and clinical specialists. A total of 30 participants completed both Delphi rounds, including 17 MS and commanding officers (Group 1) and 13 WSM (Group 2) with deployment experience in Uruzgan, Afghanistan, ensuring balanced representation of care providers, facilitators and recipients.

Primary outcome: identification of military-oriented preconditions essential for patient-centred and value-based trauma care. Secondary outcome: conceptual contribution to the future development of patient-centred outcome measures for military trauma populations.

Consensus was reached on 10 preconditions perceived as important or very important. While Group 1 prioritised operational readiness and procedural efficiency, Group 2 emphasised communication, shared decision-making and family involvement. Both groups rated informed consent, timely treatment registration and patient safety as the most critical elements, demonstrating convergence between logistic-oriented and patient-oriented perspectives.

Integrating VBHC principles into military medical doctrine can reconcile operational readiness with patient-centred care. The consensus-based preconditions identified in this study provide a foundation for developing measurable outcomes that reflect value for both patients and the military health system and can guide future VBHC implementation in trauma-related operational care.

Inguinal hernia repair is one of the most frequently performed operations in the paediatric population and can be performed according to two approaches: open or laparoscopic. At present, decisive evidence about the best treatment strategy is lacking and consequently, there is an ongoing debate about the most (cost-)effective treatment for the paediatric inguinal hernia. The aim of the Hernia Endoscopic oR opeN repair In chIldren Analysis—trial (HERNIIA2-trial) is to estimate the (cost-)effectiveness of the laparoscopic percutaneous internal ring suturing (PIRS) technique compared with open repair in children aged 0–16 years with a primary unilateral inguinal hernia.

A national multicentre randomised controlled trial will be performed including 464 children aged 0–16 years with a primary unilateral inguinal hernia. Patients will be randomised between the open or PIRS technique. The primary outcome is the number of reoperations within 2 years after primary surgery. Secondary outcome measures are: operative and postoperative complications, total duration of surgery, postoperative pain, length of admission, time to normal daily activities, cosmetic appearance of the scar, social and healthcare costs and health-related quality of life. Furthermore, cost-effectiveness will be assessed from a societal and healthcare perspective.

The protocol was approved by the ethics committee of the Amsterdam University Medical Hospital. Informed consent will be obtained by parents and, if possible, according to age, by patient. The study will be conducted according to the principles of the Declaration of Helsinki (2013) and in accordance with the Medical Research Involving Human Subjects Act (WMO) and Good Clinical Practice. Study findings will be disseminated through scientific publications, conferences and patient-friendly materials. The national study network of participating centres will facilitate rapid dissemination and implementation within the Netherlands and potentially abroad.

ClinicalTrials.gov PRS (ID NCT06451432).