Variation in Surgical Management of Asymptomatic Umbilical Hernia at Freestanding Children's Hospitals
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In brief
In brief
Multi-center study reveals 8.9-fold variation in timing of asymptomatic umbilical hernia repair across 38 children's hospitals, with early repair rates (≤3 years) ranging from 7% to 54%. Variation persists after adjusting for patient factors and repair urgency, suggesting many children undergo surgery for hernias that might spontaneously close with observation.
Written by the GCMD Library team from the article.
Purpose
To examine hospital-level variation in the timing of asymptomatic umbilical hernia repair in children.
Methods
Retrospective analysis of children undergoing umbilical hernia repair at 38 children's hospitals using the Pediatric Health Information System database (01/2013–12/2017). Early repair was defined as surgery performed at 3 years of age or younger. Repairs were categorized as emergent/urgent if associated with diagnostic or procedural codes indicating obstruction or strangulation, or if they occurred within 2 weeks of an emergency department encounter. Multivariable regression was used to calculate hospital-level observed-to-expected (O/E) ratios for early repair adjusting for emergent/urgent repair and patient characteristics.
Results
23,144 children were included, of which 30% underwent early repair (hospital range: 6.9%–54.3%, p ≪ 0.001). Overall, 3.8% of all repairs were emergent/urgent, and higher rates of early repair did not correlate with higher rates of emergent/urgent repair across hospitals (r = −0.10). Following adjustment, hospital-level O/E ratios for early repair varied 8.9-fold (0.19–1.70, p ≪ 0.001).
Conclusion
Timing of asymptomatic umbilical hernia repair varies widely across children's hospitals, and the magnitude of this variation cannot be explained by differences in patient characteristics or the acuity of repair. Many children may be undergoing repair of hernias that may spontaneously close with further observation.
Level of Evidence.
Level III (retrospective comparative study).