Kathryn Taylor1, Kristin A Sonderman2, Lindsey L Wolf3, Wei Jiang4, Lindsey B Armstrong5, Tracey P Koehlmoos6, Brent R Weil5, Robert L Ricca6, Christopher B Weldon5, Adil H Haider3, Samuel E Rice-Townsend5. 1. Harvard Medical School, Boston, MA. 2. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA; Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: ksonderman@bwh.harvard.edu. 3. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA; Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA. 4. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA. 5. Department of Surgery, Boston Children's Hospital, Boston, MA. 6. Uniformed Services University of the Health Sciences, Bethesda, MD.
Abstract
PURPOSE: We aimed to describe the incidence, timing, and predictors of recurrence following inguinal hernia repair (IHR) in children. METHODS: We used the TRICARE claims database, a national cohort of >3 million child dependents of members of the U.S. Armed Forces. We abstracted data on children <12y who underwent IHR (2005-2014). Our primary outcome was recurrence (ICD9-CM diagnosis codes). We calculated incidence rates for the population and stratified by age, time from repair to recurrence, and multivariable logistic regression to determine predictors. RESULTS: Nine thousand nine hundred ninety-three children met inclusion criteria. Age at time of IHR was ≤1y in 37%, 2-3y in 23%, 4-5y in 16%, and 5-12y in 24%. Median follow-up time was 3.5y (IQR:1.6-6.1). 137 patients recurred (1.4%), with an incidence of 3.46 per 1000 person-years. Over half occurred in children 0-1y at repair (60%). The majority occurred within a year following repair (median 209 days [IQR:79-486]). Children 0-1y had 2.53 times greater odds of recurrence (compared to >5y). Children with multiple comorbidities had 5.45 times greater odds compared to those with no comorbidities. CONCLUSIONS: The incidence of recurrence following IHR is 3.46 per 1000 person-years. The majority occurred within a year of repair. Children ≤1y and those with multiple comorbidities were at increased risk. LEVEL OF EVIDENCE: Prognosis Study, Level II.
PURPOSE: We aimed to describe the incidence, timing, and predictors of recurrence following inguinal hernia repair (IHR) in children. METHODS: We used the TRICARE claims database, a national cohort of >3 million child dependents of members of the U.S. Armed Forces. We abstracted data on children <12y who underwent IHR (2005-2014). Our primary outcome was recurrence (ICD9-CM diagnosis codes). We calculated incidence rates for the population and stratified by age, time from repair to recurrence, and multivariable logistic regression to determine predictors. RESULTS: Nine thousand nine hundred ninety-three children met inclusion criteria. Age at time of IHR was ≤1y in 37%, 2-3y in 23%, 4-5y in 16%, and 5-12y in 24%. Median follow-up time was 3.5y (IQR:1.6-6.1). 137 patients recurred (1.4%), with an incidence of 3.46 per 1000 person-years. Over half occurred in children 0-1y at repair (60%). The majority occurred within a year following repair (median 209 days [IQR:79-486]). Children 0-1y had 2.53 times greater odds of recurrence (compared to >5y). Children with multiple comorbidities had 5.45 times greater odds compared to those with no comorbidities. CONCLUSIONS: The incidence of recurrence following IHR is 3.46 per 1000 person-years. The majority occurred within a year of repair. Children ≤1y and those with multiple comorbidities were at increased risk. LEVEL OF EVIDENCE: Prognosis Study, Level II.
Authors: Jason D Young; Edward C Dee; Adele Levine; Daniel J Sturgeon; Tracey P Koehlmoos; Andrew J Schoenfeld Journal: Clin Orthop Relat Res Date: 2020-07 Impact factor: 4.755