Timing of inguinal hernia repair does not influence recurrence in premature infants

Introduction: The optimal timing of inguinal hernia repair (IHR) in premature infants remains unclear. Our study aims to compare recurrence rates between IHRs performed before and at/after 55 weeks postmenstrual age (PMA). 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 independ