Stephanie F Brierley, Brielle Ochoa, Amir Alhajjat, Emily Byrd, Stephanie D Chao, Matthew S Clifton, Christopher E Clinker, Goeto Dantes, Jose Diaz-Miron, Elizabeth A Fialkowski, Lauren Gillory, Juan P Gurria, Yigit Guner, Zaid Haddadin, Alexandra Highet, Carlos T Huerta, Olivia A Keane, Pablo Laje, Hau D Le, Justin Lee, Aaron Lesher, Samir R Pandya, Saunders Lin, Steven T Papastefan, Raphael H Parrado, Eduardo A Perez, Lorraine I Kelley-Quon, Warren Rehrer, Katie W Russell, Leigh Selesner, Blynn L Shideler, Bethany J Slater, Michael A Stellon, Caroline Stephens, Krysta M Sutyak, KuoJen Tsao, Cristine S Velazco, Nell Webber, Minna M Wieck, Peter T Yu, Daniel J Ostlie, Benjamin E Padilla
Time of repair was not an independent predictor of hernia recurrence. Therefore, recurrence risk alone should not drive the decision for early repair; rather timing should be individualized based on patient physiology, anesthetic considerations, and reliability of follow-up.
INTRODUCTION: The optimal timing of inguinal hernia repair (IHR) in premature infants remains unclear. Our study aims to compare recurrence rates between IHRs performed before and at/after 55 weeks postmenstrual age (PMA).
METHODS: A multicenter retrospective cohort study was conducted of premature infants who underwent IHR at ≤1 year of age between 1/2017-12/2019. The primary outcome was inguinal hernia recurrence, defined as recurrence requiring surgical re-repair. Demographic, clinical, perioperative and postoperative variables were analyzed. Multivariable logistic regression was performed to identify factors associated with recurrence.
RESULTS: A total of 2,412 premature infants underwent 3,808 IHRs: 3,292 (86.4%) hernias were repaired early (before 55 weeks PMA), and 516 (13.6%) were repaired late (after 55 weeks PMA). Incarceration rates were similar between the groups (9.4% vs. 8.2%, p=0.422), as were the proportion of repairs performed laparoscopically (30.0% vs. 31.2%, p=0.594). Patients undergoing early repair were more frequently admitted postoperatively (81.2% vs. 27.2%, p<0.001). There were no significant differences in hernia recurrence (1.2% vs. 0.8%, p=0.358) or time to recurrence (3 months [IQR 2.0, 9.0] vs. 9 months [IQR 4.3, 11.5], p=0.218) between early and late repair groups. On multivariable regression, laparoscopic repair (OR 1.910 [95% CI 1.018, 3.581], p=0.044) and concurrent procedure (OR 2.046 [95% CI 1.034, 4.047], p=0.040) were independently associated with a higher risk of recurrence, while late repair was not (OR 0.749 [95% CI 0.259, 2.165], p=0.593).
CONCLUSION: Time of repair was not an independent predictor of hernia recurrence. Therefore, recurrence risk alone should not drive the decision for early repair; rather timing should be individualized based on patient physiology, anesthetic considerations, and reliability of follow-up.