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Costs and recurrence of inguinal hernia repair in premature infants during neonatal admission

      Highlights

      • What is currently known about this topic? Timing of inguinal hernia repair in premature infants is variable. Early repair, during admission in the neonatal intensive care unit (NICU) may be encouraged due to concerns about hernia incarceration, strangulation, or loss to follow up. On the other hand, delayed repair might be encouraged due to concerns about increased perioperative risk in premature infants.
      • What new information is contained in this article? In premature infants, inguinal hernia repair that is performed during initial hospitalization in the NICU is associated with lower cost, but higher recurrence rates, when compared to delayed repair.

      Abstract

      Background

      Timing of inguinal hernia repair (IHR) in premature infants remains variable, yet the impact of IHR timing on procedure costs and recurrence is unclear. We sought to compare cost and recurrence rates of IHR in premature infants based on timing of repair.

      Methods

      We performed a retrospective cohort study using MarketScan insurance claims data from 2007-2018 to evaluate IHR occurring within 365 days of birth in preterm infants (gestational age [GA]<37 weeks at birth). Patients were stratified based on timing of IHR: those occurring during and after neonatal discharge. Hernia recurrences within one year following IHR were identified. Patient demographic characteristics and costs were compared between groups. Time to recurrence and cumulative recurrence hazards were estimated using Kaplan Meier analysis and Cox proportional hazards regression.

      Results

      We identified 3,662 preterm infants with IHR within 365 days of birth; 1,054(28.8%) occurred early. Infants with IHR during NICU stay were more likely to have GA at birth≤32 weeks (74.7% vs. 37.2%; p<0.01) and birthweight<1500g (83.0% vs. 40.3%; p<0.01) compared to post-NICU IHR. The hernia recurrence rate was higher and total procedure costs lower in early IHR. Early IHR (HR:1.86, 95% CI: 1.56-2.22), incarcerated/strangulated hernia (HR:1.86, 95% CI:1.49-2.32), GA≤32 weeks (HR: 1.40, 95% CI: 1.19-1.65), and congenital anomalies (HR: 1.32, 95% CI: 1.12-1.57) were predictors of hernia recurrence.

      Conclusion

      Using insurance claims data, IHR performed during initial neonatal admission was associated with lower cost, but higher recurrence rate, when compared to delayed repairs in preterm infants.

      Keywords

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