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Optimal Timing of Inguinal Hernia Repair in Premature Infants: A NSQIP-P Study
Marla A Sacks1, Dan Neal2, Seyed Pairawan3
1Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California.
Insights
Outpatient inguinal hernia repair (IHR) in premature infants appears safe for select cases, showing comparable outcomes to inpatient procedures. This study analyzed 30-day outcomes for premature neonates undergoing IHR, suggesting outpatient care is a viable option.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes Research
Background:
- Inguinal hernias affect up to 30% of premature infants.
- The optimal setting (inpatient vs. outpatient) for inguinal hernia repair (IHR) in premature neonates remains debated.
- This study compares 30-day outcomes of inpatient versus outpatient IHR.
Purpose of the Study:
- To compare the 30-day postoperative outcomes of inpatient versus outpatient inguinal hernia repair (IHR) in premature infants.
- To evaluate the safety and efficacy of different settings for IHR in a high-risk neonatal population.
Main Methods:
- Retrospective cohort study utilizing the National Surgical Quality Improvement Program-Pediatric database (2013-2019).
- Compared demographic and clinical data of 928 patients undergoing inpatient versus outpatient IHR.
- Propensity matching was performed to control for patient characteristics.
Main Results:
- Inpatient IHR involved younger infants with lower gestational age and higher preoperative oxygen needs.
- Propensity-matched analysis revealed inpatient IHR was associated with longer procedure/anesthetic times, higher rates of wound infection, blood transfusion, unplanned intubation, and reoperation.
- Inpatient IHR also showed increased postoperative hospital stay and readmissions compared to outpatient IHR.
Conclusions:
- Inpatient IHR in premature neonates is associated with different, and often adverse, postoperative outcomes compared to outpatient IHR.
- Outpatient IHR may be a safe option for select premature infants, particularly in the elective setting, pending further prospective research.
Introduction:
Among premature infants, the incidence of inguinal hernias is reported to be as high as 30%. Despite being one of the most commonly performed procedures, the optimal setting of inguinal hernia repair (IHR) that is inpatient versus outpatient remains debatable. We sought to compare the 30-day outcomes of each approach by querying the National Surgical Quality Improvement Program-Pediatric database.
Materials And Methods:
A retrospective cohort study comparing inpatient versus outpatient IHR using the National Surgical Quality Improvement Program-Pediatric database from 2013 to 2019 was performed. Demographic and clinical data were initially compared using univariate analysis. Continuous variables are presented as median and interquartile range and categorical variables are presented as n (%). Subsequently, cohorts were propensity matched using clinically and statistically significant patient characteristics.
Results:
928 patients underwent IHR, 634 (68.3%) while inpatient, 294 (31.7%) following hospital discharge. Inpatient IHR was associated with lower age at the time of surgery (120 versus 147 d; P < 0.0001), younger gestational age (27 versus 33 wk; P < 0.0001), decreased probability of repair in elective setting (87.2% versus 97.3%; P < 0.0001), and increased preoperative supplemental oxygen need (42% versus 4.4%; P < 0.0001). Comparison of propensity matched cohorts revealed that inpatient IHR was associated with increased procedure time (82 versus 51 min; P < 0.0001) and anesthetic duration (146 versus 102 min; P < 0.0001), wound infection rates (3.8% versus 0%; P = 0.007), blood transfusions (4.2% versus 0.5%; P = 0.036), unplanned intubations (2.8% versus 0%; P = 0.03), ventilator days (0 versus 0; range [0,30 versus 0,2]; P = 0.002), reoperation rate (5.6% versus 0%; P < 0.001), postoperative hospital length of stay (4 versus 1 d; P < 0.0001), and unplanned readmissions (8.9% versus 0.9%; P = 0.002).
Conclusions:
Inpatient IHR in premature neonates were associated with different postoperative outcomes than outpatient IHR. At least in the elective setting among premature infants, outpatient IHR can be considered safe in select patients while we await higher quality prospective data.
