Incarceration rates in pediatric inguinal hernia: do not trust the coding.

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.