title: Does timing of neonatal inguinal hernia repair affect outcomes?
abstract: OBJECTIVE
  The purpose of this study was to examine practice variability and compare outcomes between early and delayed neonatal inguinal hernia repair (IHR).
  
  
  METHODS
  Patients admitted to neonatal intensive care units with a diagnosis of IH who underwent IHR by age 1 year in the Pediatric Health Information System from 1999 to 2011 were included. IHR after the index hospitalization was considered delayed. Inter-hospital variability in the proportion of delayed repairs and differences in outcomes for each group were compared. A propensity score matched analysis was performed to account for baseline differences between treatment groups.
  
  
  RESULTS
  Of the 2030 patients identified, 32.9% underwent delayed IHR with significant variability in the proportion of patients having delayed repair across hospitals (p<0.0001). More patients in the delayed group had a congenital anomaly or received life supportive measures prior to IHR (all p<0.01), and 8.2% of patients undergoing delayed repair had a diagnosis of incarceration at repair. More patients in the early group underwent reoperation for hernia within 1 year (5.9% vs. 3.7%, p=0.02). Results were similar after performing a propensity score matched analysis.
  
  
  CONCLUSIONS
  Significant variability in practice exists between children's hospitals in the timing of IHR, with delayed repair associated with incarceration and early repair with a higher rate of reoperation.
authors.affiliation: Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sulkowski
authors.affiliation: Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.affiliation: Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital, Nashville, TN.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Duggan
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Atlanta, Atlanta, GA.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Balci
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston, Boston, MA.
authors.forename: Seema P
authors.initials: SP
authors.lastname: Anandalwar
authors.affiliation: Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital, Nashville, TN.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Atlanta, Atlanta, GA.
authors.forename: Kurt
authors.initials: K
authors.lastname: Heiss
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston, Boston, MA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Rangel
authors.affiliation: Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH. Electronic address: katherine.deans@nationwidechildrens.org.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
mesh_terms: D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061646:Operative Time; D057216:Propensity Score; D024162:Second-Look Surgery; D016896:Treatment Outcome
keywords: Delayed repair; Inguinal hernia; Inguinal hernia repair; Neonate; PHIS