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Epidemiology of abdominal wall and groin hernia repairs in children
Lindsey L Wolf1,2,3, Kristin A Sonderman4,5,6,7, Nicollette K Kwon1,2
1Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
This study analyzed over 19,000 pediatric hernia repairs, finding significant variations in surgical timing based on hernia type. Umbilical hernias had the longest delays, highlighting a need for further research into optimal repair timing.
Area of Science:
- Pediatric surgery
- Health services research
- Epidemiology
Background:
- Hernia repair is a common surgical procedure in children.
- Understanding the patterns of elective versus non-elective repairs is crucial for healthcare resource allocation.
- Variations in surgical timing may indicate underlying differences in disease progression or healthcare access.
Purpose of the Study:
- To estimate the prevalence, incidence, and surgical timing for elective and non-elective hernia repairs in children.
- To analyze the differences in repair timing across various hernia types (inguinal, umbilical, ventral, femoral).
- To describe the burden of hernia repair surgery in the pediatric population within the U.S. Military Health System.
Main Methods:
- Retrospective cohort study utilizing the 2005-2014 DoD Military Health System Data Repository.
- Inclusion of over 3 million child dependents (<18 years).
- Primary outcome: initial hernia repair, stratified by elective/non-elective status and age; calculation of prevalence, incidence rates, and time from diagnosis to repair.
Main Results:
- 19,398 pediatric hernia repairs were analyzed, with inguinal hernias being the most common.
- Prevalence of non-elective repairs varied from 6% (umbilical) to 22% (ventral).
- Repair timing differed significantly by hernia type, with umbilical hernias having the longest median delay (66 days) compared to inguinal (20 days), ventral (23 days), and femoral (0 days).
Conclusions:
- The study quantifies the burden of pediatric hernia repair and highlights significant heterogeneity in surgical timing.
- The substantial variation in time from diagnosis to repair, particularly for umbilical hernias, warrants further investigation.
- Identifying mechanisms behind this heterogeneity is essential to determine optimal surgical timing for different hernia types.
Purpose:
We sought to estimate the prevalence, incidence, and timing of surgery for elective and non-elective hernia repairs.
Methods:
We performed a retrospective cohort study, abstracting data on children < 18 years from the 2005-2014 DoD Military Health System Data Repository, which includes > 3 million dependents of U.S. Armed Services members. Our primary outcome was initial hernia repair (inguinal, umbilical, ventral, or femoral), stratified by elective versus non-elective repair and by age. We calculated prevalence, incidence rate, and time from diagnosis to repair.
Results:
19,398 children underwent hernia repair (12,220 inguinal, 5761 umbilical, 1373 ventral, 44 femoral). Prevalence of non-elective repairs ranged from 6% (umbilical) to 22% (ventral). Incidence rates of elective repairs ranged from 0.03 [95% CI: 0.02-0.04] (femoral) to 8.92 [95% CI: 8.76-9.09] (inguinal) per 10,000 person-years, while incidence rates of non-elective repairs ranged from 0.005 [95% CI: 0.002-0.01] (femoral) to 0.68 [95% CI: 0.64-0.73] (inguinal) per 10,000 person-years. Inguinal (median = 20, interquartile range [IQR] = 0-46 days), ventral (median = 23, IQR = 5-62 days), and femoral hernias (median = 0, IQR = 0-12 days) were repaired more promptly and with less variation than umbilical hernias (median = 66, IQR = 23-422 days).
Conclusions:
These data describe the burden of hernia repair in the U.S. The large variation in time between diagnosis and repair by hernia type identifies an important area of research to understand mechanisms underlying such heterogeneity and determine the ideal timing for repair.
Level Of Evidence:
Prognosis study II.
