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Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data
Andreas Heydweiller1, Ralf Kurz1, Arne Schröder2
1Sektion Kinderchirurgie, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Insights
Large-scale data on pediatric inguinal hernia surgery is lacking. This study analyzed German hospital data, revealing decreasing repair rates, predominantly open procedures, and rare recurrences in children.
Area of Science:
- Pediatric Surgery
- Health Services Research
Background:
- Limited large-scale data exists for pediatric inguinal hernia surgery compared to adults.
- German administrative hospital data provides a valuable resource for analyzing pediatric surgical trends.
Purpose of the Study:
- To analyze the current landscape of inpatient inguinal hernia repair in children using German administrative data.
- To identify trends in diagnosis, surgical approach, and outcomes over time.
Main Methods:
- Analysis of aggregated German hospital reimbursement data for pediatric inguinal hernia diagnoses and repairs.
- Utilized regression analysis for temporal trends and nonparametric comparisons for group differences.
Main Results:
- Decreasing overall rates of inguinal hernia repair, with exceptions for incarcerated hernias in infants.
- Open surgery is the predominant approach; laparoscopy is mainly used in older females.
- Recurrent hernia repairs are infrequent, and repair rates decrease with age.
Conclusions:
- Inpatient pediatric hernia repair is predominantly open surgery with low recurrence rates.
- Observed decreasing trends in hernia repair rates warrant further investigation.
- The proportion of repairs performed by pediatric surgeons is increasing.
Background:
Contrary to adult inguinal hernia surgery, large-scale investigations using registries or administrative data are missing in paediatric surgery. We aimed to fill this gap by analysing German administrative hospital data to describe the current reality of inpatient hernia surgery in children.
Methods:
We analysed aggregated data files bought from the German federals statistics office on hospital reimbursement data separately for principal diagnoses of inguinal hernia in children and for herniotomies in inpatients. Developments over time were assessed via regression and differences between groups with nonparametric comparisons.
Results:
Principal diagnoses of hernias were decreasing over time with the exception of male bilateral and female bilateral incarcerated hernias in the first year of life which increased. The vast majority of operations were conducted via the open approach and laparoscopy was increasingly only used for females older than 1 year of age. Recurrent hernia repair was scarce. Rates of inguinal hernia repair were higher in both sexes the younger the patient was, but were also decreasing in all age groups despite a population growth since 2012. The amount of inguinal hernia repairs by paediatric surgeons compared to adult surgeons increased by 1.5% per year.
Conclusions:
Our results corroborate previous findings of age and sex distribution. It demonstrates that inpatient hernia repair is primarily open surgery with herniorrhaphy and that recurrences seem to be rare. We observed decreasing rates of hernia repairs over time and as this has been described before in England, future studies should try to elucidate this development.
Level Of Evidence:
III.
