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Outpatient inguinal herniorrhaphy in premature infants: is it safe?
J H Melone1, M Z Schwartz, K R Tyson
1Department of Surgery, University of California, Davis School of Medicine.
Insights
Outpatient inguinal hernia repair in premature infants is safe, with low rates of apnea and bradycardia. This study found no perioperative deaths in 124 premature infants undergoing the procedure.
Area of Science:
- Pediatric Surgery
- Neonatology
Background:
- Postoperative apnea and bradycardia are concerns in premature infants undergoing inguinal herniorrhaphy.
- Outpatient repair has historically not been recommended for these patients.
Purpose of the Study:
- To review the experience of performing outpatient inguinal herniorrhaphy in premature infants.
- To assess the safety and outcomes of this procedure in a specific patient population.
Main Methods:
- A retrospective review of 1,294 outpatient inguinal herniorrhaphies performed between 1985 and 1990.
- Identification of 124 premature infants (<= 36 weeks gestational age) within the study group.
- Analysis of patient demographics, anesthetic techniques, operative details, and postoperative complications.
Main Results:
- No perioperative deaths occurred in the 124 premature infants.
- One patient experienced apnea immediately after extubation, resolving within 4 hours.
- Two patients had brief apneic episodes post-discharge and two experienced bradycardia, all with no lasting sequelae.
- Two patients required brief postoperative ventilation.
Conclusions:
- Outpatient inguinal herniorrhaphy can be safely performed in selected premature infants.
- Careful patient selection and monitoring are crucial for successful outpatient management.
- The study demonstrates a low incidence of significant complications, challenging previous recommendations against outpatient procedures.
Abstract:
Because postoperative apnea and bradycardia in premature infants following inguinal herniorrhaphy remains a concern, outpatient repair has not been recommended. We have been performing outpatient inguinal herniorrhaphy in premature infants and the present study reviews our experience. Between 1985 and 1990, 1,294 outpatient inguinal herniorrhaphies were performed. Of this group 124 patients (9.6%) were identified as being premature (less than or equal to 36 weeks gestational age). Average ages were: gestational age 32.7 weeks (range, 24 to 36 weeks); postnatal age 12.6 weeks (range, 3 to 24 weeks); and postconceptional age (gestational plus postnatal) 45.3 weeks (range, 34 to 59 weeks). Twenty-two infants previously required ventilatory support, 11 patients had apnea/bradycardia, and 9 patients developed bronchopulmonary dysplasia. General anesthesia (usually nitrous oxide and fluothane) was used in all patients and 75% underwent endotracheal intubation. The average operating room time was 40 minutes (range, 20 to 115 minutes) and the average recovery room time was 94 minutes (range, 30 to 240 minutes). There were no perioperative deaths. One patient became apneic immediately after extubation in the operating room. No further episodes were noted after 4 hours of observation. Another patient following discharge had a brief apneic episode at home while on an apnea monitor, which was relieved with gentle stimulation. Both patients had no further sequelae. Bradycardia to 80 beats/min was noted in two patients, and resolved spontaneously in the recovery room. Laryngospasm after extubation in the operating room occurred in two patients, one of whom required brief reintubation and the other resolved spontaneously. Two patients required postoperative ventilation: one was extubated in the recovery room and the other was hospitalized for 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
