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Factors associated with inguinal hernia repair in premature infants during neonatal admission
Adesola C Akinkuotu1, Mya Roberson2, Paula D Strassle3
1Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Houpt Physicians' Office Building, Campus Box 7223 170 Manning Drive Chapel Hill, NC 27599-7223, USA.
Insights
Early inguinal hernia repair (IHR) in premature infants is influenced by race and hospital type. Non-Hispanic White females at urban teaching hospitals were more likely to receive early IHR.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Health Services Research
Background:
- Timing of inguinal hernia repair (IHR) in premature infants varies significantly.
- Factors influencing early IHR, defined as repair during initial neonatal admission, are not well understood.
Purpose of the Study:
- To evaluate factors associated with early IHR in premature infants.
- To identify demographic, procedural, and hospital characteristics influencing IHR timing.
Main Methods:
- Analysis of neonatal hospitalizations for premature infants with inguinal hernia (2010-2017) using HCUP databases.
- Multivariable Cox proportional hazard models assessed associations with early IHR.
Main Results:
- Over 30,000 hospitalizations were analyzed; 43.3% underwent early IHR.
- Older gestational age, female sex, and concomitant gastrostomy increased likelihood of early IHR.
- Non-Hispanic Black infants, and those at urban non-teaching or rural hospitals had lower odds of early IHR.
Conclusions:
- Early IHR in premature neonates is more common in non-Hispanic White females at urban teaching hospitals.
- Patient race and hospital type significantly determine early IHR.
- Further research is needed on race and socioeconomic factors impacting outcomes of pediatric operations.
Introduction:
Timing of inguinal hernia repair (IHR) in premature infants is variable and influenced by surgeon preference and complication profile. The purpose of this study was to evaluate factors related to early IHR, defined as hernia repair during initial neonatal admission, in premature infants.
Methods:
Neonatal hospitalizations of premature infants (gestational age at birth < 37 weeks and ≤ 28 days old at admission), with a diagnosis of inguinal hernia from 2010 to 2017 in HCUP National Inpatient Sample and Kid's Inpatient Sample databases were evaluated. Multivariable Cox proportional hazard models was used to estimate associations between demographics, additional procedures, hospital characteristics, and early IHR.
Results:
Overall, 30,298 neonatal hospitalizations of premature infants with inguinal hernia were identified; 13,228 (43.3%) underwent early IHR. Early IHR was more likely with older gestational age at birth (35-36 weeks vs < 24 weeks, HR 6.05, 95% CI 4.17, 8.79), female sex (HR 1.20, 95% CI 1.07, 1.34), and undergoing concomitant gastrostomy (HR 2.51, 95% CI 1.72, 3.66). Non-Hispanic Black infants (HR 0.84, 95% CI 0.75, 0.95), infants at urban non-teaching hospitals (HR 0.15, 95% CI 0.07, 0.33), and infants at rural hospitals (HR 0.81, 95% CI 0.70, 0.97) were less likely to undergo early IHR.
Conclusions:
Using a nationally representative database, early IHR in premature neonates was more commonly performed in non-Hispanic White, female neonates and at urban teaching hospitals. Patient race and hospital type were determinants of early IHR in premature neonates. There is a need to further evaluate the impact of race and socioeconomic factors on outcomes of common pediatric operations like inguinal hernia repairs.
Level Of Evidence:
Level III.
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