Timing of inguinal hernia repair does not influence recurrence in premature infants.
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История · было → стало
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Brierley Stephanie F, Ochoa Brielle, Alhajjat Amir, Byrd Emily, Chao Stephanie D, Clifton Matthew S, Clinker Christopher E, Dantes Goeto, Diaz-Miron Jose, Fialkowski Elizabeth A, Gillory Lauren, Gurria Juan P, Guner Yigit, Haddadin Zaid, Highet Alexandra, Huerta Carlos T, Keane Olivia A, Laje Pablo, Le Hau D, Lee Justin, Lesher Aaron, Pandya Samir R, Lin Saunders, Papastefan Steven T, Parrado Raphael H, Perez Eduardo A, Kelley-Quon Lorraine I, Rehrer Warren, Russell Katie W, Selesner Leigh, Shideler Blynn L, Slater Bethany J, Stellon Michael A, Stephens Caroline, Sutyak Krysta M, Tsao KuoJen, Velazco Cristine S, Webber Nell, Wieck Minna M, Yu Peter T, Ostlie Daniel J, Padilla Benjamin E
Аннотация
METHODS: A multicenter retrospective cohort study was conducted of premature infants who underwent IHR at ≤1 year of age between 1/2017-12/2019. The primary outcome was inguinal hernia recurrence, defined as recurrence requiring surgical re-repair. Demographic, clinical, perioperative and postoperative variables were analyzed. Multivariable logistic regression was performed to identify factors associated with recurrence.
RESULTS: A total of 2412 premature infants underwent 3808 IHRs: 3292 (86.4%) hernias were repaired early (before 55 weeks PMA), and 516 (13.6%) were repaired late (after 55 weeks PMA). Incarceration rates were similar between the groups (9.4% vs. 8.2%, p = 0.422), as were the proportion of repairs performed laparoscopically (30.0% vs. 31.2%, p = 0.594). Patients undergoing early repair were more frequently admitted postoperatively (81.2% vs. 27.2%, p < 0.001). There were no significant differences in hernia recurrence (1.2% vs. 0.8%, p = 0.358) or time to recurrence (3 months [IQR 2.0, 9.0] vs. 9 months [IQR 4.3, 11.5], p = 0.218) between early and late repair groups. On multivariable regression, laparoscopic repair (OR 1.910 [95% CI 1.018, 3.581], p = 0.044) and concurrent procedure (OR 2.046 [95% CI 1.034, 4.047], p = 0.040) were independently associated with a higher risk of recurrence, while late repair was not (OR 0.749 [95% CI 0.259, 2.165], p = 0.593).
CONCLUSION: Time of repair was not an independent predictor of hernia recurrence. Therefore, recurrence risk alone should not drive the decision for early repair; rather timing should be individualized based on patient physiology, anesthetic considerations, and reliability of follow-up.