Anesthesiology September 2024, Vol. 141, A13–A15.
Effect of early vs late inguinal hernia repair on serious adverse event rates in preterm infants: A randomized clinical trial. JAMA 2024; 331:1035–44. PMID: 38530261.
Inguinal hernia repair in premature neonates is associated with morbidity, but it is controversial whether repair should be done before or after intensive care unit (ICU) discharge. This multicenter (39 U.S. sites) randomized infants to either early (N = 172) or late (N = 166, age older than 55 postmenstrual weeks). The primary outcome was occurrence of any prespecified serious adverse event during the 10-month observation period. The mean ± SD gestational birth age was 26.6 ± 2.8 weeks; the mean ± SD postnatal age at enrollment was 12 ± 5 weeks. At follow-up, 159 (early) and 149 (late) had complete data. The primary outcome was significantly lower with late repair (18% vs. 28%, risk difference, −7.9% [95% credible interval, −16.9 to 0%]). The median days in the hospital during the 10-month observation period was 19.0 (interquartile range, 9.8 to 35.0) in the early group versus 16.0 (7.0 to 38.0) in the late group (82% posterior probability of benefit with late repair). The probability that late repair reduced the number of infants with at least one serious adverse event was higher in infants younger than 28 weeks’ gestational age and in those with bronchopulmonary dysplasia (99% probability of benefit).
Take home message: In this multicenter randomized study of timing of neonatal inguinal hernia repair, late repair after ICU discharge resulted in a significant reduction in serious adverse events over the intervening 10-month period. Benefits appeared to be greatest in younger infants and in those with bronchopulmonary dysplasia.