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. 2023 Mar;58(3):445-452.
doi: 10.1016/j.jpedsurg.2022.10.006. Epub 2022 Oct 22.

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

Alyssa E Peace  1 , Emilie D Duchesneau  2 , Chris B Agala  1 , Michael R Phillips  1 , Sean E McLean  1 , Andrea A Hayes  1 , Adesola C Akinkuotu  3
Affiliations

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

Alyssa E Peace et al. J Pediatr Surg. 2023 Mar.

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 to 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<1500 g (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.

Type of study: Retrospective study LEVEL OF EVIDENCE: Level III.

Keywords: Cost analysis; Hernia repair; Inguinal hernia; Neonatal intensive care unit; Prematurity.

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Figures

Figure 1.
Figure 1.
Schematic of inclusion of cohort of premature infants with inguinal hernia, undergoing hernia repair in the MarketScan Database, from 2007 to 2008
Figure 2:
Figure 2:
Kaplan-Meier curve illustrating time to hernia recurrence in premature infants undergoing inguinal hernia repair from 2007–2018.
See this image and copyright information in PMC

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