title: Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs.
abstract: Inguinal hernia repair is frequently performed in premature infants. Evidence on optimal management and timing of repair, as well as related medical costs is still lacking. The objective of this study was to determine the direct medical costs of inguinal hernia, distinguishing between premature infants who had to undergo an emergency procedure and those who underwent elective inguinal hernia repair.
  
  
  
  This cohort study based on medical records concerned premature infants with inguinal hernia who underwent surgical repair within 3 months after birth in a tertiary academic children's hospital between January 2010 and December 2013. Two groups were distinguished: patients with incarcerated inguinal hernia requiring emergency repair and patients who underwent elective repair. Real medical costs were calculated by multiplying the volumes of healthcare use with corresponding unit prices. Nonparametric bootstrap techniques were used to derive a 95 % confidence interval (CI) for the difference in mean costs.
  
  
  
  A total of 132 premature infants were included in the analysis. Emergency surgery was performed in 29 %. Costs of hospitalization comprised 65 % of all costs. The total direct medical costs amounted to €7418 per premature infant in the emergency repair group versus €4693 in the elective repair group. Multivariate analysis showed a difference in costs of €1183 (95 % CI -1196; 3044) in favor of elective repair after correction for potential risk factors.
  
  
  
  Emergency repair of inguinal hernia in premature infants is more expensive than elective repair, even after correction for multiple confounders. This deserves to be taken into account in the debate on timing of inguinal hernia repair in premature infants.
authors.affiliation: Department of Surgery, Erasmus University Medical Center (Erasmus MC) Rotterdam, PO Box 2040, 3000, CA Rotterdam, The Netherlands. j.verhelst@erasmusmc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Verhelst
authors.affiliation: Department of Surgery, Erasmus University Medical Center (Erasmus MC) Rotterdam, PO Box 2040, 3000, CA Rotterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: de Goede
authors.affiliation: Department of Epidemiology and Radiology, Erasmus University Medical Center (Erasmus MC) Rotterdam, Rotterdam, The Netherlands.
authors.forename: B J H
authors.initials: BJ
authors.lastname: van Kempen
authors.affiliation: Department of Paediatric Surgery, Erasmus University Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: H R
authors.initials: HR
authors.lastname: Langeveld
authors.affiliation: Department of Paediatric Surgery, Erasmus University Sophia Children's Hospital, Rotterdam, The Netherlands.|Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Poley
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Kazemier
authors.affiliation: Department of Neuroscience, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Jeekel
authors.affiliation: Department of Paediatric Surgery, Erasmus University Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: R M H
authors.initials: RM
authors.lastname: Wijnen
authors.affiliation: Department of Surgery, Erasmus University Medical Center (Erasmus MC) Rotterdam, PO Box 2040, 3000, CA Rotterdam, The Netherlands.
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D002648:Child; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000191:economics*; D004630:Emergencies / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006552:Hernia, Inguinal / Q000191:economics* / Q000601:surgery; D059685:Herniorrhaphy / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000191:economics* / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cost analysis; Emergency repair; Inguinal hernia; Premature infants