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Association between COVID-19 related elective surgery cancellations and pediatric inguinal hernia complications: A
Andrew Hu1, Audra J Reiter1, Rodrigo Gerardo2
1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL.
Insights
COVID-19 surgery cancellations for pediatric inguinal hernia repair were safe, showing no increase in incarceration or emergency department visits despite slight repair delays. These findings support the safety of elective surgery postponements in children.
Area of Science:
- Pediatric Surgery
- Public Health Policy
- Infectious Disease Epidemiology
Background:
- The optimal timing for pediatric inguinal hernia repair is debated.
- The impact of COVID-19 related elective surgery cancellations on inguinal hernia repair timing and complications is not well understood.
- This study investigates the safety of these cancellations in pediatric patients.
Purpose of the Study:
- To determine if COVID-19 related elective surgery cancellations impacted the timing of pediatric inguinal hernia repair.
- To assess whether any delays in repair led to increased complications such as incarceration or emergency department (ED) encounters.
- To evaluate the overall safety of elective surgery cancellations in pediatric inguinal hernia cases.
Main Methods:
- A multicenter retrospective cohort study involving 14 children's hospitals.
- Included patients aged 18 years or younger who underwent inguinal hernia repair between September 2019 and September 2020.
- Compared outcomes (incarceration, ED encounters) for repairs performed before and after hospital-specific COVID-19 elective surgery cancellation dates.
Main Results:
- Out of 1,404 patients, 604 (43.0%) had repairs post-cancellation.
- The post-cancellation period was not significantly associated with higher rates of incarceration (OR 1.54) or ED encounters (OR 1.53).
- Median repair time increased slightly post-cancellation (29 vs. 31 days), with infants showing higher rates of ED presentation.
Conclusions:
- COVID-19 elective surgery cancellations did not increase the risk of incarceration or ED visits for pediatric inguinal hernias.
- The findings suggest that elective surgery cancellations are safe for children with inguinal hernias, even with minor repair delays.
- This research has significant implications for health policy regarding surgical cancellations during public health crises.
Background:
Optimal inguinal hernia repair timing remains controversial. It remains unclear how COVID-19 related elective surgery cancellations impacted timing of inguinal hernia repair and whether any delays led to complications. This study aims to determine whether elective surgery cancellations are safe in pediatric inguinal hernia.
Methods:
This multicenter retrospective cohort study at 14 children's hospitals included patients ≤18 years who underwent inguinal hernia repair between September 13, 2019, through September 13, 2020. Patients were categorized by whether their inguinal hernia repair occurred before or after their hospital's COVID-19 elective surgery cancellation date. Incarceration and emergency department encounters were compared between pre and postcancellation.
Results:
Of 1,404 patients, 604 (43.0%) underwent inguinal hernia repair during the postcancellation period, 92 (6.6%) experienced incarceration, and 213 (15.2%) had an emergency department encounter. The postcancellation period was not associated with incarceration (odds ratio 1.54; 95% confidence interval 0.88-2.71; P = .13) or emergency department encounters (odds ratio 1.53; 95% confidence interval 0.94-2.48; P = .09) despite longer median times to inguinal hernia repair (precancellation 29 days [interquartile range 13-55 days] versus postcancellation 31 days [interquartile range 14-73 days], P = .01). Infants were more likely to have the emergency department be their index presentation in the postcancellation period (odds ratio 1.69; 95% confidence interval 1.24-2.31; P < .01).
Conclusion:
Overall, COVID-19 elective surgery cancellations do not appear to increase the likelihood of incarceration or emergency department encounters despite delays in inguinal hernia repair, suggesting that cancellations are safe in children with inguinal hernia. Assessment of elective surgery cancellation safety has important implications for health policy.
