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Published on: February 10, 2023
Incarceration rates in pediatric inguinal hernia: do not trust the coding
Suad Gholoum1, Robert Baird, Jean-Martin Laberge
1Division of Pediatric General Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada H3H 1P3.
Insights
In children undergoing inguinal hernia repair, patient age and wait times did not significantly increase incarceration risk. The study found International Classification of Diseases, version 10 (ICD-10) coding to be an inaccurate measure of actual irreducibility.
Area of Science:
- Pediatric Surgery
- Hernia Repair
- Surgical Outcomes
Background:
- Recent reports suggest optimal wait times for inguinal hernia repair to prevent incarceration.
- These optimal wait times may not be universally applicable or feasible due to resource limitations.
- Patient age and the interval to operation are potential factors influencing incarceration risk.
Purpose of the Study:
- To evaluate the relationship between patient age, interval to operation, and the risk of inguinal hernia incarceration in children.
- To determine if current recommendations for wait times are applicable across different pediatric age groups.
- To assess the accuracy of International Classification of Diseases, version 10 (ICD-10) coding for hernia incarceration.
Main Methods:
- Retrospective review of 268 children younger than 2 years undergoing inguinal hernia repair (2004-2007).
- Patients categorized by age at diagnosis: 0-28 days, 4-26 weeks, 27-52 weeks, and 53-104 weeks.
- Incarceration rates assessed, comparing ICD-10 coding with clinical reduction without sedation; wait times and daily incarceration risk calculated per age group.
Main Results:
- Overall mean wait time was 43 ± 50 days.
- True incarceration rate was 8% (22/268), with 18 incarcerated at presentation.
- No significant difference in incarceration rates observed across age groups (5.3% to 11.5%), despite longer wait times in older children.
Conclusions:
- International Classification of Diseases, version 10 (ICD-10) coding overestimates hernia incarceration.
- Hernia incarceration in children awaiting repair is infrequent.
- Strict wait time protocols may not significantly alter the overall risk of incarceration in pediatric inguinal hernias.
Purpose:
Although recent reports have suggested optimal wait times for inguinal hernia repair to prevent incarceration, these may not apply to all patients or be feasible in the context of limited resources. We evaluated our experience to determine if patient age and interval to operation increased the risk of incarceration.
Methods:
A retrospective review of children younger than 2 years old undergoing inguinal hernia repair from 2004 to 2007 was performed. Patients were divided based on age at diagnosis (A, 0-28 days; B, 4-26 weeks; C, 27-52 weeks; and D, 53-104 weeks). We evaluated incarceration rates in each group, defined as the need for sedation to achieve reduction, and compared these to International Classification of Diseases, version 10 (ICD-10), coding. Wait times were evaluated, and the rate and daily risk of incarceration were calculated for each age group.
Results:
Two hundred sixty-eight patients were included in our analysis, with an overall mean wait time of 43 +/- 50 days between diagnosis and surgery. Forty-five patients were labeled as incarcerated by ICD-10 coding, although 23 patients (51%) were reduced without sedation, leaving a true incarceration rate of 8% (22/268). Of these 22 patients, 18 were incarcerated at index presentation. There was no difference in incarceration rates between groups (A, 5.3%; B, 8.0%; C, 11.5%; and D, 8.8%), although older patients had significantly longer wait times.
Conclusions:
Our study suggests that ICD-10 coding of incarceration is an inaccurate parameter of actual irreducibility. Hernia incarceration in children awaiting repair represented a minority of overall incarcerations in our cohort, suggesting strict wait times may not alter incarceration risk.
