Association between COVID-19 related elective surgery cancellations and pediatric inguinal hernia complications: A nationwide multicenter cohort study
Authors
Andrew Hu, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL. Electronic address: ahu1@northwestern.edu.
Audra J. Reiter, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL.
Rodrigo Gerardo, Division of Pediatric Surgery, Wright State University, Dayton Children's Hospital, OH.
Nicholas J. Skertich, Division of Pediatric Surgery, Rush University, Children's Hospital in Chicago, IL.
Ruth Lewit, Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN.
Muhammad Ghani, Department of Pediatric Surgery, Vanderbilt University Medical Center, Vanderbilt Children's Hospital, Nashville, TN.
Amanda Witte, Division of Pediatric Surgery, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI.
Hae-Sung Kang, Department of Pediatric Surgery, Virginia Commonwealth University, Children's Hospital of Richmond, VA.
Holden Richards, Department of Pediatric Surgery, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR.
Bradley Perry, Division of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI.
Yao Tian, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL.
Steven C. Mehl, Department of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Andres Gonzalez, Department of Pediatric Surgery, Johns Hopkins Medicine, Johns Hopkins Children's Center, Baltimore, MD.
Nathan M. Novotny, Division of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI.
Jeffrey Haynes, Department of Pediatric Surgery, Virginia Commonwealth University, Children's Hospital of Richmond, VA.
Arturo Aranda, Division of Pediatric Surgery, Wright State University, Dayton Children's Hospital, OH.
Irving J. Zamora, Department of Pediatric Surgery, Vanderbilt University Medical Center, Vanderbilt Children's Hospital, Nashville, TN.
Daniel Rhee, Department of Pediatric Surgery, Johns Hopkins Medicine, Johns Hopkins Children's Center, Baltimore, MD.
Elizabeth Fialkowski, Department of Pediatric Surgery, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR.
Bethany J. Slater, Advocate Aurora HealthFollow
Kyle Van Arendonk, Division of Pediatric Surgery, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI.
Ankush Gosain, Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN.
Monica E. Lopez, Department of Pediatric Surgery, Vanderbilt University Medical Center, Vanderbilt Children's Hospital, Nashville, TN.
Mehul V. Raval, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL.
Recommended Citation
Hu A, Reiter AJ, Gerardo R, et al. Association between COVID-19 related elective surgery cancellations and pediatric inguinal hernia complications: A nationwide multicenter cohort study. Surgery. 2022;172(3):989-996. doi:10.1016/j.surg.2022.05.011
Abstract
Background: Optimal inguinal hernia repair timing remains controversial. It remains unclear how COVID-19 related elective surgery cancellations impacted timing of inguinal hernia repair and whether any delays led to complications. This study aims to determine whether elective surgery cancellations are safe in pediatric inguinal hernia.
Methods: This multicenter retrospective cohort study at 14 children's hospitals included patients ≤18 years who underwent inguinal hernia repair between September 13, 2019, through September 13, 2020. Patients were categorized by whether their inguinal hernia repair occurred before or after their hospital's COVID-19 elective surgery cancellation date. Incarceration and emergency department encounters were compared between pre and postcancellation.
Results: Of 1,404 patients, 604 (43.0%) underwent inguinal hernia repair during the postcancellation period, 92 (6.6%) experienced incarceration, and 213 (15.2%) had an emergency department encounter. The postcancellation period was not associated with incarceration (odds ratio 1.54; 95% confidence interval 0.88-2.71; P = .13) or emergency department encounters (odds ratio 1.53; 95% confidence interval 0.94-2.48; P = .09) despite longer median times to inguinal hernia repair (precancellation 29 days [interquartile range 13-55 days] versus postcancellation 31 days [interquartile range 14-73 days], P = .01). Infants were more likely to have the emergency department be their index presentation in the postcancellation period (odds ratio 1.69; 95% confidence interval 1.24-2.31; P < .01).
Conclusion: Overall, COVID-19 elective surgery cancellations do not appear to increase the likelihood of incarceration or emergency department encounters despite delays in inguinal hernia repair, suggesting that cancellations are safe in children with inguinal hernia. Assessment of elective surgery cancellation safety has important implications for health policy.
