Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery

We determined the rate of incarceration of inguinal hernia among infants and young children waiting for elective surgery and examined the relation to wait times. We also explored the relation between wait times and the use of emergency department services before surgery. We used linked data from adm...

Full description

Saved in:
Bibliographic Details
Published in:Canadian Medical Association journal 2008-11, Vol.179 (10), p.1001-1005
Main Authors: Zamakhshary, Mohammed, MD MEd, To, Teresa, MSc PhD, Guan, Jun, MSc, Langer, Jacob C., MD
Format: Article
Language:English
Subjects:
Access control
Age Factors
Care and treatment
Child, Preschool
Children
Children & youth
Complications and side effects
Databases as Topic
Demographic aspects
Diseases
Elective Surgical Procedures
Emergency Service, Hospital - utilization
Female
Health care delivery
Hernia, Inguinal - complications
Hernia, Inguinal - surgery
Hernias
Hospitals
Humans
Infant
Inguinal hernia
Logistic Models
Male
Medical research
Ontario
Risk Assessment
Sex Factors
Surgery
Surgery, Elective
Waiting Lists
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We determined the rate of incarceration of inguinal hernia among infants and young children waiting for elective surgery and examined the relation to wait times. We also explored the relation between wait times and the use of emergency department services before surgery. We used linked data from administrative databases to identify infants and children less than 2 years of age who underwent surgical repair of an inguinal hernia between Apr. 1, 2002, and Mr. 31, 2004. We determined the rate of hernia incarceration during the wait for surgery and stratified the risk by patient age and sex. We used logistic regression analysis to examine factors associated with hernia incarceration and wait times. A total of 1065 infants and children less than 2 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 1 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 1 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 (1 visit, OR 2.73, 95% 1.65-4.50; > or = 2 visits, OR 3.77, 95% CI 1.89-7.43). Children less than 1 year old who waited longer than 14 days had a significant 2-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.
ISSN:0008-4409
0820-3946
1488-2329
DOI:10.1503/cmaj.070923