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From the Division of General Surgery, The Hospital for Sick Children (Zamakhshary, Langer), Toronto, Ont.; the King Saud bin Abdulaziz University for Health Sciences and the King Abdullah International Medical Research Center, King Abdulaziz Medical City (Zamakhshary), Riyadh, Saudi Arabia; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children (To, Langer), Toronto, Ont.; and the Institute for Clinical Evaluative Sciences (To, Guan), Toronto, Ont.
Correspondence to: Dr. Jacob C. Langer, Division of General Surgery, Rm. 1526, The Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8; fax 416 813-7477; jacob.langer{at}sickkids.ca
Background: We determined the rate of incarceration of inguinal hernia among infants and young children waiting for elective surgery and examined the relation to wait times. We also explored the relation between wait times and the use of emergency department services before surgery.
Methods: We used linked data from administrative databases to identify infants and children less than 2 years of age who underwent surgical repair of an inguinal hernia between Apr. 1, 2002, and Mr. 31, 2004. We determined the rate of hernia incarceration during the wait for surgery and stratified the risk by patient age and sex. We used logistic regression analysis to examine factors associated with hernia incarceration and wait times.
Results: A total of 1065 infants and children less than 2 years old underwent surgical repair of an inguinal hernia during the study period. The median wait time was 35 days (interquartile range 17–77 days). Within 30 days after diagnosis, 126 (11.8%) of the patients had at least 1 emergency department visit; 23.8% of them presented with hernia incarceration. The overall rate of hernia incarceration was 11.9%. The rate was 5.2% with a wait time of up to 14 days (median time from diagnosis to first emergency department visit), as compared with 10.1% with a wait time of up to 35 days (median wait time to surgery) (p < 0.001). Factors associated with an increased risk of incarcerated hernia were age less than 1 year (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.32–3.23), female sex (OR 1.75, 95% CI 1.04–2.93) and emergency department visits (1 visit, OR 2.73, 95% 1.65–4.50; 
2 visits, OR 3.77, 95% CI 1.89–7.43). Children less than 1 year old who waited longer than 14 days had a significant 2-fold risk of incarcerated hernia (OR 1.92, 95% CI 1.11–3.32).
Interpretation: A wait time for surgery of more than 14 days was associated with a doubling of the risk of hernia incarceration among infants and young children with inguinal hernia. Our data support a recommendation that inguinal hernias in this patient population be repaired within 14 days after diagnosis.
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