Practice Variation in Umbilical Hernia Repair Demonstrates a Need for Best Practice Guidelines

Area of Science:

• Pediatric Surgery
• Health Services Research
• Surgical Outcomes

Background:

• Umbilical hernia repair is a common pediatric surgical procedure.
• Practice patterns for timing of repair can vary widely.
• Understanding these variations is crucial for optimizing patient care.

Purpose of the Study:

• To analyze variations in the age of umbilical hernia repair.
• To identify patient, hospital, and geographic factors associated with repair timing.
• To assess practice pattern differences across demographically diverse states.

Main Methods:

• Cross-sectional descriptive study using ambulatory surgery claims data.
• Analysis of uncomplicated umbilical hernia repairs as a single procedure (2012-2014).
• Inclusion of data from Wisconsin, New York, and Florida.

Main Results:

• Significant variability in repair timing was observed across states (P < .001).
• Race, Medicaid insurance, and rural residence predicted earlier repair.
• African American patients were less likely to have repair before age 2 (OR 0.62).
• Rural children (OR 1.53) and Medicaid patients (OR 2.01) were more likely to have early repair.

Conclusions:

• The age at which pediatric umbilical hernia repair is performed shows considerable variation.
• Umbilical hernias can resolve spontaneously, supporting a watchful waiting approach.
• Formal guidelines are recommended to guide delayed repair and reduce unnecessary operations.