Timing of Pediatric Incarcerated Inguinal Hernia Repair: A Review of Nationwide Readmissions Data

• Published in: The Journal of surgical research 2024-03, Vol.295, p.641-646
• Main Authors: Ramsey, Walter A., Huerta, Carlos T., O’Neil, Christopher F., Taylor, Ruby R., Saberi, Rebecca A., Gilna, Gareth P., Collie, Brianna L., Lyons, Nicole B., Parreco, Joshua P., Thorson, Chad M., Sola, Juan E., Perez, Eduardo A.
• Format: Article
• Language: English
• Subjects: Incarcerated inguinal hernia; Inguinal hernia repair; Pediatric inguinal hernia; Readmission
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2023.11.059

In pediatric patients, incarcerated inguinal hernias are often repaired on presentation. We hypothesize that in appropriate patients, repair may be safely deferred. The Nationwide Readmissions Database was used to identify pediatric patients (aged < 18 y) with incarcerated inguinal hernia from 2010 to 2014. Patients were stratified by management approach (Early Repair versus Deferral). Overall frequencies of these operative strategies were calculated. Propensity score matching was then performed to control for patient age, comorbidities, perinatal conditions, and congenital anomalies. Outcomes including complications, surgical procedures, and readmissions were compared. Outpatient surgeries were not assessed. Among 6148 total patients with incarcerated inguinal hernia, the most common strategy was to perform Early Repair (88% versus 12% Deferral). Following propensity score matching, the cohort included 1288 patients (86% male, average age 1.7 ± 4.1 years). Deferral was associated with equivalent rates of readmission within one year (13% versus 15%, P = 0.143), but higher readmissions within the first 30 days (7% versus 3%, P = 0.002) than Early Repair. Deferral patients had lower rates of orchiectomy (2% versus 5%, P = 0.001), wound infections (< 2% versus 2%, P = 0.020), and other infections (7% versus 15%, P