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Provincial Review of Adherence to Age-specific Guidelines for Umbilical Hernia Repair and Trends in Management
Shadi Hadj-Youssef1, Félix Rondeau2, Kossi Thomas Golo3
1School of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montréal, QC, Canada.
Insights
Pediatric umbilical hernia (UH) repair in Quebec shows high guideline adherence. Early surgical repair, particularly for those with comorbidities or living far from hospitals, increased costs significantly.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Public Health
Background:
- Umbilical hernia (UH) is common in children, with guidelines recommending delayed surgical repair until after age 3 for asymptomatic cases to allow for spontaneous closure.
- Understanding adherence to these guidelines, surgical timing, and associated costs is crucial for optimizing pediatric care.
Purpose of the Study:
- To evaluate adherence to age-specific guidelines for umbilical hernia repair in Quebec.
- To determine the rate of urgent surgical repair, associated outcomes, and costs.
- To analyze interinstitutional referral patterns for pediatric UH repair.
Main Methods:
- A population-based retrospective cohort study analyzed health administrative data for children aged 28 days to 17 years undergoing UH repair from 2010 to 2020.
- Exclusion criteria included multiple procedures or prolonged peri-operative stays.
- Early repair was defined as elective surgery at or under age 3.
Main Results:
- Of 3215 children, 89.7% received guideline-adherent care.
- Higher risk of early repair was observed in patients living >75 km from hospitals (OR 2.36), with comorbidities (OR 2.82), or treated in tertiary centers (OR 2.10).
- Repair at or under age 3 and urgent surgery were associated with significant cost increases ($411 and $558, respectively).
Conclusions:
- Quebec demonstrates high adherence to age-specific guidelines for pediatric umbilical hernia repair.
- Factors influencing transfers to tertiary centers warrant further investigation regarding resource utilization.
- The study highlights the financial implications of early and urgent surgical interventions for UH.
Background:
Umbilical hernia (UH) is a common pediatric condition, for which delaying surgical repair for asymptomatic UH until after age 3 is recommended due to a high incidence of spontaneous closure. We aimed to determine the adherence to guidelines, rate of urgent surgical repair, outcomes, cost, and interinstitutional referral patterns of UH repair in the province of Quebec (Canada).
Methods:
This was a population-based retrospective cohort study of children 28 days to 17 years old who underwent UH repair between 2010 and 2020 using health administrative databases. Children who had multiple procedures, or prolonged peri-operative stays were excluded. Early repair was defined as elective surgery at or under age 3.
Results:
Of the 3215 children, 1744 (54.2%) were female, and 1872 (58.2%) were treated in a tertiary children's hospital. Guidelines were respected for 2853 out of 3215 children (89.7%). Patients living over 75 km from their treating hospitals (OR 2.36, 95% CI 1.33-4.16, P < 0.01), with pre-existing comorbidities (OR, 2.82; 95% CI, 1.96-4.05; P < 0.001), or being treated in a tertiary center (OR 2.10, 95% CI 1.45-3.03, P < 0.001) had a higher risk of early repair. Repair at or under age 3 and urgent surgery were associated with significant cost increases of 411$ (P < 0.001) and 558$ (P < 0.001), respectively.
Conclusion:
Quebec has a high rate of adherence to age-specific guidelines for UH repair. Future research should explore factors that explain transfers into tertiary centers, and the extent to which these reflect efficient use of resources.
Level Of Evidence:
level III.
Type Of Study:
Retrospective comparative study.
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