The authors determined the rate of incarceration of inguinal hernia among infants and young children waiting for elective surgery and examined the relation to wait times. They also explored the relation between wait times and the use of emergency department services before surgery.
The authors used linked data from administrative databases to identify infants and children less than two years of age who underwent surgical repair of an inguinal hernia between April 1, 2002 and March 31, 2004. They determined the rate of hernia incarceration during the wait for surgery and stratified the risk by patient age and sex. They used logistic regression analysis to examine factors associated with hernia incarceration and wait times.
A total of 1,065 infants and children less than two years old underwent surgical repair of an inguinal hernia during the study period. The median wait time was 35 days (interquartile range 17–77 days). Within 30 days after diagnosis, 126 (11.8%) of the patients had at least one emergency department visit; 23.8% of them presented with hernia incarceration. The overall rate of hernia incarceration was 11.9%. The rate was 5.2% with a wait time of up to 14 days (median time from diagnosis to first emergency department visit), as compared with 10.1% with a wait time of up to 35 days (median wait time to surgery) (p < 0.001). Factors associated with an increased risk of incarcerated hernia were age less than one year (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.32–3.23), female sex (OR 1.75, 95% CI 1.04–2.93) and emergency department visits (one visit, OR 2.73, 95% 1.65–4.50; two visits, OR 3.77, 95% CI 1.89–7.43). Children less than one year old who waited longer than 14 days had a significant two-fold risk of incarcerated hernia (OR 1.92, 95% CI 1.11–3.32).
A wait time for surgery of more than 14 days was associated with a doubling of the risk of hernia incarceration among infants and young children with inguinal hernia. Our data support a recommendation that inguinal hernias in this patient population be repaired within 14 days after diagnosis.
