Introduction

Timing of inguinal hernia repair (IHR) in premature infants is variable and influenced by surgeon preference and complication profile. The purpose of this study was to evaluate factors related to early IHR, defined as hernia repair during initial neonatal admission, in premature infants.

Methods

Neonatal hospitalizations of premature infants (gestational age at birth < 37 weeks and ≤ 28 days old at admission), with a diagnosis of inguinal hernia from 2010 to 2017 in HCUP National Inpatient Sample and Kid's Inpatient Sample databases were evaluated. Multivariable Cox proportional hazard models was used to estimate associations between demographics, additional procedures, hospital characteristics, and early IHR.

Results

Overall, 30,298 neonatal hospitalizations of premature infants with inguinal hernia were identified; 13,228 (43.3%) underwent early IHR. Early IHR was more likely with older gestational age at birth (35–36 weeks vs < 24 weeks, HR 6.05, 95% CI 4.17, 8.79), female sex (HR 1.20, 95% CI 1.07, 1.34), and undergoing concomitant gastrostomy (HR 2.51, 95% CI 1.72, 3.66). Non-Hispanic Black infants (HR 0.84, 95% CI 0.75, 0.95), infants at urban non-teaching hospitals (HR 0.15, 95% CI 0.07, 0.33), and infants at rural hospitals (HR 0.81, 95% CI 0.70, 0.97) were less likely to undergo early IHR.

Conclusions

Using a nationally representative database, early IHR in premature neonates was more commonly performed in non-Hispanic White, female neonates and at urban teaching hospitals. Patient race and hospital type were determinants of early IHR in premature neonates. There is a need to further evaluate the impact of race and socioeconomic factors on outcomes of common pediatric operations like inguinal hernia repairs.

Level of Evidence

Level III.

中文翻译：

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新生儿入院时早产儿腹股沟疝修补的相关因素

介绍

早产儿腹股沟疝修补术 (IHR) 的时间是可变的，并受外科医生偏好和并发症情况的影响。本研究的目的是评估与早产儿早期 IHR 相关的因素，定义为初始新生儿入院期间的疝气修复。

方法

评估了 2010 年至 2017 年在 HCUP 国家住院样本和儿童住院样本数据库中诊断为腹股沟疝的早产儿（出生胎龄 < 37 周且入院时 ≤ 28 天）的新生儿住院情况。多变量 Cox 比例风险模型用于估计人口统计学、附加程序、医院特征和早期 IHR 之间的关联。

结果

总体而言，确定了 30,298 名患有腹股沟疝的早产儿新生儿住院；13,228 (43.3%) 人接受了早期 IHR。出生时胎龄较大（35-36 周 vs < 24 周，HR 6.05, 95% CI 4.17, 8.79）、女性（HR 1.20, 95% CI 1.07, 1.34）和同时接受胃造口术的人更可能出现早期 IHR (HR 2.51, 95% CI 1.72, 3.66)。非西班牙裔黑人婴儿（HR 0.84, 95% CI 0.75, 0.95），城市非教学医院的婴儿（HR 0.15, 95% CI 0.07, 0.33）和农村医院的婴儿（HR 0.81, 95% CI 0.70, 0.97) 不太可能接受早期 IHR。

结论

使用具有全国代表性的数据库，早产儿的早期 IHR 更常见于非西班牙裔白人、女性新生儿和城市教学医院。患者种族和医院类型是早产儿早期 IHR 的决定因素。有必要进一步评估种族和社会经济因素对常见儿科手术（如腹股沟疝修补术）结果的影响。

证据水平

三级。