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Impact of wait time on outcome for inguinal hernia repair in infants
Li Ern Chen1, Mohammed Zamakhshary, Robert P Foglia
1St. Louis Children's Hospital, Washington University School of Medicine, Saint Louis, MO, USA.
Insights
Longer surgical wait times for infant inguinal hernia repair correlate with increased incarceration rates and emergency department use. Strategies to reduce wait times are crucial for pediatric surgical systems with limited resources.
Area of Science:
- Pediatric Surgery
- Health Services Research
Background:
- Prolonged surgical wait times pose challenges in healthcare systems.
- Inguinal hernias are common in infants, requiring timely surgical intervention.
Purpose of the Study:
- To investigate the relationship between surgical wait times and adverse outcomes in pediatric inguinal hernia repair.
- To compare outcomes between two pediatric surgical centers with differing wait times.
Main Methods:
- Retrospective data collection from two pediatric surgical centers (Canadian and American).
- Inclusion criteria: children under 2 years with inguinal hernia presenting in 2002-2003.
- Analysis of wait times, incarceration rates, recurrent incarceration, and emergency department (ED) usage.
Main Results:
- Canadian center had significantly longer wait times (99 days) compared to the American center (27 days) for hernia repair (P < 0.001).
- Higher incidence of incarceration and recurrent incarceration observed in the Canadian center.
- Increased emergency department utilization at diagnosis and during the wait period in the Canadian center.
Conclusions:
- Extended wait times for infant inguinal hernia repair are linked to higher incarceration rates and increased ED resource utilization.
- Findings highlight the need for strategies to shorten surgical wait times in resource-limited pediatric surgical settings.
Background:
Prolonged surgical wait times are a problem in many health care systems. We used data from two pediatric surgical centers, one Canadian and one American, in order to determine if increased wait times are related to rates of incarceration and adverse outcomes.
Methods:
Data were collected for children under the age of 2 who presented with an inguinal hernia to either the emergency department or clinic in the two hospitals in 2002 and 2003.
Results:
Infants in the Canadian center were older at presentation and were more likely to present to the emergency department. Wait time for hernia repair was longer in the Canadian than the American hospital (99 +/- 103 vs. 27 +/- 53 days, P < 0.001). The incidence of incarceration was higher in the Canadian hospital, and infants in the Canadian center were more likely to have episodes of recurrent incarceration. Emergency department usage was greater in the Canadian hospital both at the time of diagnosis as well as during the waiting period for surgery.
Discussion:
Prolonged wait time for inguinal hernia repair in infants is associated with a higher rate of incarceration as well as greater usage of emergency department resources. These data are important for those surgeons working in systems with limited resources in which strategies to shorten wait times are necessary.