S. Saylors1, C. Nonnemacher1, C. Snyder1, P. Aguayo1, R. Hendrickson1, B. Mullapudi1, I. Lim-Beutel1, R. Rentea1, S. St. Peter1, D. Juang1, T. Oyetunji1 1Children’s Mercy Hospital- University Of Missouri Kansas City, Pediatric Surgery, Kansas City, MO, USA
Introduction: Inguinal hernia repair is one of the most common pediatric surgical procedures performed with an estimated incidence of 1-5% in children. Patients can present with or without symptoms, with symptomatic hernias (incarcerated or strangulated) that may require emergent or urgent operative intervention. During the Covid-19 pandemic, restrictions, and shutdowns of elective surgeries at our institution resulted in delaying elective inguinal hernia repair unless presenting with more emergent symptoms, with no apparent increase in complication. In our institution, this practice was continued even after COVID restrictions were lifted, with elective repairs delayed until patients were older before completing elective inguinal hernia repair to also reduce early exposure to anesthesia. The aim of this study is to document the outcomes from this change in practice including risk of incarceration/complications in these infants.
Methods: Children <1 years old who underwent inguinal hernia repairs from January 2018 – January 2024 treated at a single freestanding children’s hospital were reviewed. Patients admitted to the NICU during surgical management or who’s index presentation was in the emergency department were excluded. Procedures prior to March 1, 2020, were considered pre-Covid while subsequent operations were categorized as post-Covid. In the latter group, surgical repair was delayed until approximately 6 months of age. Details of their hospitalization, including demographic, operative, and length of stay data, as well as post-operative complications including return to ER, re-admission, and recurrence of hernia(s) were collected.
Results: A total of 179 patients were included and majority were male (85%, n=153). One-third of patients underwent surgical repair prior to Covid restrictions (32%, n=58) while 68% of patients (n=121) were repaired during/after Covid restrictions. The average time from diagnosis of hernia(s) to surgery in the pre-Covid group was 44 days compared to 74 days in the post-Covid group (p=0.0001). The average age of patients at time of surgery was 125 days in the pre-Covid group compared to 152 days in the post-Covid group (p=0.034). There was no increase in the rate of patient presentation to the Emergency Department/hernia incarceration rate in the post-Covid group (10% pre- vs 8% post-). There were no observed differences in operative characteristics or post-operative complications between groups.
Conclusion: In the outpatient setting, delaying inguinal hernia repair in infants does not increase the risk of hernia incarceration or complications in these patients. Potential benefits of delaying surgery include allowing patients to grow while also avoiding early anesthetic exposure in infancy.