O1107: Factors Influencing Inguinal Hernia Recurrence in Neonatal Intensive Care Unit Infants

Background: Inguinal hernia is one of the most common surgical diagnoses affecting children, particularly premature infants. However, outcomes following early or delayed repair tend to describe healthy outpatients. Infants in the intensive care unit have unique risks and timing considerations. We aim to explore the patient and operative factors that may be associated with higher risk of hernia recurrence in this population.

Methods: We queried the Pediatric Health Information System for patients admitted to the neonatal critical care unit between 2016-2021 within 30 days of delivery and underwent an inguinal hernia repair surgery during the same hospital stay. A control group of non-critical-care patients who underwent hernia repair was formulated using propensity score matching. Patients requiring mechanical ventilation were classified into 2 groups: preoperative only versus peri/postoperative ventilation. Bowel resection was used as a proxy for hernia strangulation. Recurrence rates were evaluated.

Results: A total of 4,138 patients were included. Most patients were white (53%), male (87.9%), and were preterm (91.9%). Median [IQR] age at the time of hernia repair was 97 days [69-130]. Most patients had a bilateral hernia repair (58%), and repair was performed using the open technique in 70.9% of patients. Unadjusted results are shown in Table1. On multivariable logistic regression, postoperative mechanical ventilation was the factor most associated with same-side recurrence (OR4.52, 95%CI 2.31-8.86). Female patients had lower odds of same-side recurrence (OR 0.21, 95%CI 0.05-0.85) compared to males. Requiring bowel resection at the time of surgery and undergoing bilateral repairs were associated with higher odds of recurrence (OR2.32, 95%CI 1.25-4.30] and (OR3.22, 95%CI 1.44-7.17), respectively. The duration of mechanical ventilation was positively associated with subsequent contralateral hernia repair, while the patient’s age in days at the time of the initial surgery was inversely associated with the same risk. Open repair was associated with higher odds of contralateral hernia (OR2.21, 95%CI 1.18-4.12).

Conclusion: Inguinal hernia repair in infants has an overall low risk of recurrence; however, this risk is significantly increased in infants undergoing repair while in an intensive care unit, particularly if there is a need for bowel resection. Repair when patients are less critically ill seems to be associated with lower risk of recurrence, however, this should be weighed against the risk of incarceration.