دورية أكاديمية
Timing of Pediatric Incarcerated Inguinal Hernia Repair: A Review of Nationwide Readmissions Data.
العنوان: | Timing of Pediatric Incarcerated Inguinal Hernia Repair: A Review of Nationwide Readmissions Data. |
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المؤلفون: | Ramsey WA; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: walter.ramsey@jhsmiami.org., Huerta CT; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., O'Neil CF Jr; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., Taylor RR; University of Miami Miller School of Medicine, Miami, Florida., Saberi RA; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., Gilna GP; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., Collie BL; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., Lyons NB; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., Parreco JP; Division of Trauma and Surgical Critical Care, Memorial Regional Hospital, Hollywood, Florida., Thorson CM; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., Sola JE; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida., Perez EA; Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. |
المصدر: | The Journal of surgical research [J Surg Res] 2024 Mar; Vol. 295, pp. 641-646. Date of Electronic Publication: 2023 Dec 15. |
نوع المنشور: | Review; Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Academic Press Country of Publication: United States NLM ID: 0376340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1095-8673 (Electronic) Linking ISSN: 00224804 NLM ISO Abbreviation: J Surg Res Subsets: MEDLINE |
أسماء مطبوعة: | Publication: New York, NY : Academic Press Original Publication: Philadelphia [etc.] |
مواضيع طبية MeSH: | Hernia, Inguinal*/surgery, Pregnancy ; Female ; Humans ; Child ; Male ; Infant ; Child, Preschool ; Patient Readmission ; Prospective Studies ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Hospitalization ; Retrospective Studies |
مستخلص: | Introduction: In pediatric patients, incarcerated inguinal hernias are often repaired on presentation. We hypothesize that in appropriate patients, repair may be safely deferred. Methods: The Nationwide Readmissions Database was used to identify pediatric patients (aged < 18 y) with incarcerated inguinal hernia from 2010 to 2014. Patients were stratified by management approach (Early Repair versus Deferral). Overall frequencies of these operative strategies were calculated. Propensity score matching was then performed to control for patient age, comorbidities, perinatal conditions, and congenital anomalies. Outcomes including complications, surgical procedures, and readmissions were compared. Outpatient surgeries were not assessed. Results: Among 6148 total patients with incarcerated inguinal hernia, the most common strategy was to perform Early Repair (88% versus 12% Deferral). Following propensity score matching, the cohort included 1288 patients (86% male, average age 1.7 ± 4.1 years). Deferral was associated with equivalent rates of readmission within one year (13% versus 15%, P = 0.143), but higher readmissions within the first 30 days (7% versus 3%, P = 0.002) than Early Repair. Deferral patients had lower rates of orchiectomy (2% versus 5%, P = 0.001), wound infections (< 2% versus 2%, P = 0.020), and other infections (7% versus 15%, P < 0.001). The frequency of other complications including bowel resection, oophorectomy, testicular atrophy, sepsis, and pneumonia were equivalent between groups. Three percent of Deferrals had a diagnosis of incarceration on readmission. Conclusions: Deferral of incarcerated inguinal hernia repair at index admission is associated with higher rates of hospital readmissions within the first 30 days but equivalent readmission within the entire calendar year. These patients are at risk of repeat incarceration but have significantly lower rates of orchiectomy than their counterparts who undergo inguinal hernia repair at the index admission. We propose that prospective studies be performed to identify good candidates for Elective Deferral following manual reduction and overnight observation. Such studies must capture outpatient surgical outcomes. (Copyright © 2023 Elsevier Inc. All rights reserved.) |
فهرسة مساهمة: | Keywords: Incarcerated inguinal hernia; Inguinal hernia repair; Pediatric inguinal hernia; Readmission |
تواريخ الأحداث: | Date Created: 20231216 Date Completed: 20240226 Latest Revision: 20240226 |
رمز التحديث: | 20240226 |
DOI: | 10.1016/j.jss.2023.11.059 |
PMID: | 38103321 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1095-8673 |
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DOI: | 10.1016/j.jss.2023.11.059 |