W. A. Ramsey1, C. T. Huerta1, G. P. Gilna1, R. A. Saberi1, C. F. O’Neil1, J. P. Parreco2, C. M. Thorson1, J. E. Sola1, E. A. Perez1 1University of Miami Miller School of Medicine, DeWitt Daughtry Family Department Of Surgery, Division Of Pediatric Surgery, MIAMI, FL, USA 2Memorial Regional Hospital, Division Of Trauma And Surgical Critical Care, Hollywood, FL, USA
Introduction: In pediatric patients, incarcerated inguinal hernias are often repaired on presentation. We hypothesize that in the appropriate patient, repair may be safely deferred.
Methods: The Nationwide Readmissions Database was used to identify pediatric patients (age <18 years) with incarcerated inguinal hernia from 2010-2014. Patients were stratified by management approach (immediate repair vs deferral). Deferral patients with length of stay <2 days were classified as elective deferral. Outpatient surgeries were not assessed.
Results: There were 6,146 patients with incarcerated inguinal hernia. Immediate repair was performed in 88% of patients. Average age was 1.8 years among immediate repair and 1.6 years for deferral (p=.269). Overall incarceration on readmission was uncommon (0.4%). Those that did not undergo immediate repair were more likely to have an index hospitalization >7 days (50% vs 20%, p<0.001) and undergo another surgical procedure during index hospitalization (18% vs 15%, p=0.017) such as ostomy creation (4% vs 2%, p<0.001) or colon resection (3% vs 1%, p<0.001).
Compared to immediate repair, elective deferral (n=311) was associated with lower rates of readmission within one year (10% vs 14%, p=0.037) and fewer readmission procedures and complications (Table 1). 9% of electively deferred patients required readmission within one year with inguinal hernia repair, but only 0.9% had a diagnosis of incarceration on readmission.
Conclusion: Repair of incarcerated inguinal hernia on index admission is the most common management strategy. Deferral is more common in patients who undergo other major procedures. However, some patients may be safely deferred for elective repair.
