Incarceration rates in pediatric inguinal hernia: do not trust the coding

Purpose: Although recent reports have suggested optimal wait times for inguinal hernia repair to prevent incarceration, these may not apply to all patients or be feasible in the context of limited resources. We evaluated our experience to determine if patient age and interval to operation increased the risk of incarceration. Methods: A retrospective review of children younger than 2 years old undergoing inguinal hernia repair from 2004 to 2007 was performed. Patients were divided based on age at diagnosis (A, 0-28 days; B, 426 weeks; C, 27-52 weeks; and D, 53-104 weeks). We evaluated incarceration rates in each group, defined as the need for sedation to achieve reduction, and compared these to International Classification of Diseases, version 10 (ICD-10), coding. Wait times were evaluated, and the rate and daily risk of incarceration were calculated for each age group. Results: Two hundred sixty-eight patients were included in our analysis, with an overall mean wait time of 43 +/- 50 days between diagnosis and surgery. Forty-five patients were labeled as incarcerated by ICD-10 coding, although 23 patients (51%) were reduced without sedation, leaving a true incarceration rate of 8% (22/268). Of these 22 patients, 18 were incarcerated at index presentation. There was no difference in incarceration rates between groups (A, 5.3%; B, 8.0%; C, 11.5%; and D, 8.8%), although older patients had significantly longer wait times. Conclusions: Our study suggests that ICD-10 coding of incarceration is an inaccurate parameter of actual irreducibility. Hernia incarceration in children awaiting repair represented a minority of overall incarcerations in our cohort, suggesting strict wait times may not alter incarceration risk. (C) 2010 Elsevier Inc. All rights reserved.