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Association between Age and Umbilical Hernia Repair Outcomes in Children: A Multistate Population-Based Cohort Study
Devin R Halleran1, Peter C Minneci2, Jennifer N Cooper3
1Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
Insights
Pediatric umbilical hernia repair outcomes show higher recurrence and revisits in children under 4. Delaying repair until age 4 may improve results for asymptomatic cases.
Area of Science:
- Pediatric Surgery
- Clinical Outcomes Research
Background:
- Umbilical hernia is common in children.
- Repair timing is debated, especially for asymptomatic cases.
Purpose of the Study:
- To identify patient factors associated with recurrence and revisits after pediatric umbilical hernia repair.
- To inform optimal surgical timing for pediatric umbilical hernias.
Main Methods:
- Retrospective cohort study using large healthcare databases (2010-2014).
- Included 9809 pediatric patients undergoing umbilical hernia repair.
- Analyzed hernia recurrence and 30-day unplanned related hospital revisits.
Main Results:
- The 3-year hernia recurrence rate was 0.57%.
- Children younger than 4 years had a higher recurrence rate (HR 1.93).
- Younger children (<4 years), older children (>10 years), public insurance, asthma, and ED presentation were linked to higher revisit rates.
Conclusions:
- Younger age (<4 years) is associated with increased recurrence and revisits after umbilical hernia repair.
- Findings suggest delaying repair of asymptomatic umbilical hernias until age 4.
- Optimizing repair timing may reduce complications and healthcare utilization.
Objective:
To evaluate whether patient age or other sociodemographic and clinical characteristics are associated with recurrence or unplanned related hospital revisits after pediatric umbilical hernia repair.
Study Design:
We performed a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases of 7 states. Pediatric umbilical hernia repairs performed at any hospital or surgery center in 2010-2014 were included. Hernia recurrences and occurrences of unplanned and related hospital revisits within 30 days were evaluated.
Results:
Of 9809 included patients, 52.0% were female and 50.5% were black. The 3-year hernia recurrence rate was 0.57% (95% CI 0.42, 0.73). In multivariable analysis, the recurrence rate was higher in children <4 years of age than in children 4-10 years of age (hazard ratio [HR] 1.93, 95% CI 1.09, 3.44). Unplanned related hospital revisits within 30 days occurred in 2.5% of patients. Patient characteristics associated with the risk of an unplanned related hospital revisit included age <4 years (HR 2.17, 95% CI 1.70, 2.77) or >10 years (HR 2.11, 95% CI 1.46, 3.05), public insurance (HR 2.10, 95% CI 1.58, 2.79), asthma (HR 1.74, 95% CI 1.32, 2.29), and initial presentation to the emergency department (HR 2.46, 95% CI 1.08, 5.61).
Conclusions:
Rates of recurrence and unplanned related hospital revisits following pediatric umbilical hernia repair are higher in children younger than 4 years of age. These findings support delaying the repair of asymptomatic umbilical hernia in children until 4 years of age.
