Variation in the use of laparoscopy with inguinal hernia repairs in a sample of pediatric patients at children's hospitals

• Published in: Journal of pediatric urology 2018-04, Vol.14 (2), p.158.e1-158.e7
• Main Authors: Herbst, K.W., Thaker, H., Lockwood, G.M., Hagadorn, J.I., Masoud, S., Kokorowski, P.
• Format: Article
• Language: English
• Subjects: Cost analysis; Inguinal hernia; Laparoscopy; Pediatric; Variation
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2017.10.008

Metachronous contralateral inguinal hernias (MCH) occur in approximately 10% of pediatric patients following unilateral inguinal hernia repairs (UIHR). Laparoscopic evaluation of the contralateral internal ring is a method of identifying high-risk individuals for prophylactic contralateral exploration and repair. The objective of this study was to assess variation in utilization of diagnostic laparoscopy, and report costs associated with the evaluation of a contralateral patent processus vaginalis during hernia repair in pediatric hospitals. The Pediatric Health Information System database was searched to identify outpatient surgical encounters for pediatric patients with a diagnosis of inguinal hernia during a 1-year period (2014). Records were identified that contained diagnostic codes for unilateral or bilateral inguinal hernia in combination with a procedure code for open hernia repair with or without diagnostic laparoscopy. After exclusions there were 3952 hernia repairs performed at 30 hospitals; median age was 4 years (IQR 1–7), 78.8% were male, and 64.9% Caucasian. Three-quarters (76.7%) had UIHR, 8.6% had unilateral repairs with laparoscopy (UIHRL), 12.2% had bilateral inguinal hernia repairs (BIHR), and 2.4% had bilateral repairs with laparoscopy (BIHRL). Where laparoscopy was used, 78% resulted in a unilateral repair and 22% in a bilateral procedure. The percent of patients undergoing laparoscopy varied from 0 to 57% among hospitals, and 0–100% among surgeons. Pediatric surgeons were more than three times more likely to perform a diagnostic laparoscopy compared with pediatric urologists. Median adjusted costs were $2298 (IQR 1659–2955) for UIHR, $2713 (IQR 1873–3409) for UIHRL, $2752 (IQR 2230–3411) for BIHR, and $2783 (IQR 2233–3453) for BIHRL. Median costs varied over two-fold among hospitals ($1310–4434), and over four-fold among surgeons ($948–5040). Data suggested that