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Published on: January 7, 2019
Cost Analysis of Early vs Delayed Outpatient Repair of Inguinal Hernias in Premature Infants
Gwyneth A Sullivan1, Ethan Ritz2, Brian R Englum3
1Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
Insights
Delaying inguinal hernia repair in premature infants until they no longer require overnight apnea monitoring is more cost-effective. This approach avoids the higher costs associated with early surgical intervention and post-operative observation for premature infants.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Health Economics
Background:
- Premature infants undergoing inguinal hernia repair often require overnight post-operative observation for apnea monitoring until 50-60 weeks adjusted gestational age (AGA).
- This practice incurs significant healthcare costs.
Purpose of the Study:
- To compare the costs of early versus delayed surgical repair of inguinal hernias in premature infants.
- To determine the optimal timing for inguinal hernia repair in this population based on cost-effectiveness.
Main Methods:
- A decision analysis model was employed to estimate costs for three scenarios: delayed repair, early repair with overnight observation, and incarcerated hernia requiring delayed repair.
- Cost estimations utilized average hospital charges from a single institution.
- Sensitivity analyses explored variations in incarceration rates and delayed repair timing (50-60 weeks AGA).
Main Results:
- The base model indicated that delayed repair was consistently less expensive than early repair across all diagnosis times.
- Estimated costs for delayed repair exceeded early repair costs only at higher incarceration risks (3-4%/week) and later repair ages (55-60 weeks AGA).
Conclusions:
- Based purely on cost analysis, delaying inguinal hernia repair in premature infants diagnosed as outpatients until overnight observation is unnecessary is the more economical strategy.
- This approach minimizes healthcare expenditures without compromising patient care outcomes.
Introduction:
Premature infants treated for inguinal hernias after hospital discharge require overnight post-operative observation for apnea monitoring until 50-60 weeks adjusted gestational age (AGA). This study aimed to compare costs associated with early (at time of diagnosis) versus delayed (at AGA not requiring overnight observation) repair of inguinal hernia in premature infants.
Methods:
Costs were estimated using the average hospital charges at a single institution for three scenarios: 1) delayed repair 2) early repair requiring overnight observation, and 3) incarcerated inguinal hernia reduced but requiring delayed repair at 48 h. A decision analysis model was used to estimate the cost for premature infants undergoing delayed repair of inguinal hernia while considering the risk of incarceration and associated costs. The base model used 50 weeks AGA for delayed repair and an incarceration rate of 0.5%/week. Sensitivity analyses varied incarceration rate from 0.1 to 4%/week and delayed repair to 55 and 60 weeks AGA.
Results:
In the base model, delayed repair incurred lower estimated costs than early repair at all time points of diagnosis. In sensitivity analyses, estimated cost for delayed repair only rose above the estimated cost for early repair when estimated incarceration risk reached 3%/week with repair at 60 weeks AGA (if repair before 38 weeks AGA) or 4%/week with repair at 55 weeks AGA (if repair before 39 weeks AGA).
Conclusions:
Using solely cost as a deciding factor, repair of premature inguinal hernias diagnosed as an outpatient should be delayed until overnight observation is no longer necessary.
Type Of Study:
Decision Analysis model.
Level Of Evidence:
III.
