Abstract：
BACKGROUND: 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.
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.
摘要：
背景：在儿科患者中，嵌顿性腹股沟疝通常在出现时进行修复。我们假设在适当的患者中，修复可以安全地推迟。
方法：使用全国再入院数据库来识别2010年至2014年腹股沟嵌顿疝的儿科患者（年龄<18岁）。通过管理方法（早期修复与延期）对患者进行分层。计算了这些手术策略的总体频率。然后进行倾向评分匹配以控制患者年龄，合并症,围产期条件，和先天性异常。结果包括并发症，外科手术,和再入院进行了比较。未评估门诊手术。
结果：在6148例腹股沟嵌顿疝患者中，最常见的策略是进行早期修复(88%对12%的延迟).在倾向得分匹配之后，该队列包括1288名患者(86%为男性，平均年龄1.7±4.1岁)。延期与一年内同等的再入院率相关(13%对15%，P=0.143),但在前30天内再入院率较高(7%对3%，P=0.002）比早期修复。延迟患者的睾丸切除术率较低(2%对5%，P=0.001),伤口感染（<2%对2%，P=0.020),和其他感染(7%对15%，P<0.001)。其他并发症的频率，包括肠切除，卵巢切除术,睾丸萎缩,脓毒症,和肺炎在组间相当。百分之三的延期被诊断为再次入院时被监禁。
结论：初次入院时嵌顿性腹股沟疝修补术的延迟与前30天内住院再入院率较高相关，但在整个日历年内再入院率相当。这些患者有重复嵌顿的风险，但睾丸切除术的发生率明显低于入院时接受腹股沟疝修补术的患者。我们建议在手动减少和过夜观察后进行前瞻性研究，以确定选择性延期的良好候选人。此类研究必须捕获门诊手术结果。
方法：使用全国再入院数据库来识别2010年至2014年腹股沟嵌顿疝的儿科患者（年龄<18岁）。通过管理方法（早期修复与延期）对患者进行分层。计算了这些手术策略的总体频率。然后进行倾向评分匹配以控制患者年龄，合并症,围产期条件，和先天性异常。结果包括并发症，外科手术,和再入院进行了比较。未评估门诊手术。
结果：在6148例腹股沟嵌顿疝患者中，最常见的策略是进行早期修复(88%对12%的延迟).在倾向得分匹配之后，该队列包括1288名患者(86%为男性，平均年龄1.7±4.1岁)。延期与一年内同等的再入院率相关(13%对15%，P=0.143),但在前30天内再入院率较高(7%对3%，P=0.002）比早期修复。延迟患者的睾丸切除术率较低(2%对5%，P=0.001),伤口感染（<2%对2%，P=0.020),和其他感染(7%对15%，P<0.001)。其他并发症的频率，包括肠切除，卵巢切除术,睾丸萎缩,脓毒症,和肺炎在组间相当。百分之三的延期被诊断为再次入院时被监禁。
结论：初次入院时嵌顿性腹股沟疝修补术的延迟与前30天内住院再入院率较高相关，但在整个日历年内再入院率相当。这些患者有重复嵌顿的风险，但睾丸切除术的发生率明显低于入院时接受腹股沟疝修补术的患者。我们建议在手动减少和过夜观察后进行前瞻性研究，以确定选择性延期的良好候选人。此类研究必须捕获门诊手术结果。
