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Paediatric inguinal hernias - An increasingly urgent problem
KiloranH M Metcalfe1, Sophie Lewis1, Nick Lansdale2
1Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
Insights
Children
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Management
Background:
- Post-COVID-19 funding shortages impact pediatric surgery.
- Increased waiting times for pediatric inguinal hernia (IH) repair raise concerns.
- Delays may lead to higher morbidity and resource strain.
Purpose of the Study:
- Evaluate trends in waiting times for pediatric IH repair.
- Assess the impact of these delays on patient outcomes.
- Analyze the burden on hospital resources.
Main Methods:
- Retrospective review of 414 pediatric IH operations across two cohorts (March 2022-March 2023 and April 2023-April 2024).
- Utilized Federation of Surgical Speciality Associations guidance for prioritization and breach definitions.
- Compared waiting times, emergency operation rates, and length of stay between cohorts.
Main Results:
- A significant increase in the proportion of emergency operations was observed in the second cohort (56/234 vs. 19/180, p < 0.001).
- Median waiting times for P2 and P3 patients increased substantially, from 9.9 to 21.5 weeks and 10.1 to 23.0 weeks, respectively.
- 29 patients required emergency surgery while on the waiting list, with 18 breaching targets; emergency cases had longer hospital stays (3 days vs. 1 day for electives).
Conclusions:
- Children with IH face prolonged waiting times, leading to more emergency procedures.
- Increased emergency surgeries result in longer hospital stays and greater resource utilization.
- Expanding elective operating lists is crucial to mitigate these issues and reduce healthcare burdens.
Introduction:
Children's surgery remains underfunded after COVID-19 and waiting list times have risen. Children with inguinal hernias (IH) come into this group, and there has been concern that these delays put children at higher risk of morbidity and increases the burden on resources. The aim of this study was to evaluate trends in waiting times and establish the impact on children in a large tertiary unit.
Methods:
Retrospective review of all IH operations at a tertiary unit, 1st March 2022 - 31st March 2023 (Cohort 1) and 1st April 2023 - 30th April 2024 (Cohort 2). Federation of Surgical Speciality Associations guidance was used to define prioritisation status and breaches.
Results:
414 patients were included in the study (180 Cohort 1, 234 Cohort 2). Alongside the increase in overall operations, the proportion of emergency operations in cohort 2 was significantly higher (56/234 vs 19/180, p < 0.001). There were also increases in the median waiting times for P2 patients, from 9.9 to 21.5 weeks (p = 0.0272). For P3, this increase was from 10.1 to 23.0 weeks (p = 0.0001). In total 29 patients required an emergency operation (on the waiting list) and of these 18/29 had breached their intended target. Length of stay for emergency patients was 3 days, compared to 1 day for electives.
Conclusion:
Children with IH are experiencing longer waiting times resulting in more emergency procedures and higher hospital bed days. Increased provision of elective operating lists is needed to tackle this problem and reduce the overall burden on hospital resources.
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