Older Children Undergoing Inguinal Hernia Repair Have Higher Recurrence Rates Than Younger Children and Adults: A Nationwide Cohort Study

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-12-03 DOI:10.1016/j.jpedsurg.2024.162083

John Sincavage , Gwyneth A. Sullivan , Annie Fritsch , Zachary Palmisano , Mehul V. Raval , Martin Blakely , Ami N. Shah , Brian C. Gulack

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引用次数: 0

Abstract

Background

High ligation is the standard practice for inguinal hernia repair in children while adults undergo a floor repair. There is limited data to guide recommendations on the age at which floor repair should be considered. This is a hypothesis-generating study to understand the correlation of age and other factors with inguinal hernia recurrence in children.

Materials and methods

Children aged 6–17 years who underwent inguinal hernia repair by a pediatric surgeon between 2010 and 2022 were identified in the PearlDiver Mariner database, as were adults aged 18–25 years treated by an adult surgeon. Kaplan–Meier survival analysis and Cox proportional hazards modeling was used to determine the risk of hernia recurrence by age, sex, and obesity status.

Results

A total of 15,114 children and 20,863 adults were included. Children aged 16–17 years had a significantly increased five-year risk of hernia recurrence compared to children aged 6–10 years (2.5 % vs 0.8 %, adjusted hazard ratio [AHR]: 3.00, 95 % confidence interval [CI]: 1.98–4.56) as well as compared to the adult group (2.5 % vs 1.2 %, AHR 1.90, 95 % CI: 1.31–2.74). Obese males aged 14–17 years had the highest five-year rate of hernia recurrence of any group at 4.7 %.

Conclusions

Children 16–17 years of age who underwent inguinal hernia repair with pediatric surgeons have an increased risk of hernia recurrence compared to younger children as well as compared to adults treated by general surgeons. We hypothesize that high ligations, commonly performed by pediatric surgeons, may be inappropriate in some groups of older children.

Type of Study

Cohort.

Level of Evidence

Level III.

查看原文本刊更多论文

接受腹股沟疝修补术的大龄儿童的复发率高于年幼儿童和成人：一项全国性队列研究。

背景：高位结扎是儿童腹股沟疝修补的标准做法，而成人则进行底部修补。关于地板应考虑维修的年龄的指导建议的数据有限。这是一项假设生成研究，旨在了解年龄和其他因素与儿童腹股沟疝复发的相关性。材料和方法：在PearlDiver Mariner数据库中确定了2010年至2022年间由儿科外科医生进行腹股沟疝修补的6-17岁儿童，以及由成人外科医生治疗的18-25岁成年人。采用Kaplan-Meier生存分析和Cox比例风险模型来确定年龄、性别和肥胖状况的疝复发风险。结果：共纳入15114名儿童和20863名成人。与6-10岁儿童相比，16-17岁儿童疝复发的5年风险显著增加（2.5% vs 0.8%，校正风险比[AHR]: 3.00, 95%可信区间[CI]: 1.98-4.56），与成年组相比（2.5% vs 1.2%, AHR: 1.90, 95% CI: 1.31-2.74）。14-17岁的肥胖男性5年疝气复发率最高，为4.7%。结论：16-17岁接受儿科外科手术的腹股沟疝修补的儿童与年幼的儿童和接受普通外科医生治疗的成人相比，疝复发的风险增加。我们假设通常由儿科外科医生进行的高位结扎可能不适用于某些年龄较大的儿童。研究类型：队列。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.