Age-Dependent Costs and Complications in Pediatric Umbilical Hernia Repair

Abstract

To characterize regional variation in the age of patients undergoing umbilical hernia repair to determine costs and subsequent care. We performed a cross-sectional descriptive study using a large convenience sample of US employer-based insurance claims from July 2012 to December 2015. We identified children younger than 18years of age undergoing uncomplicated (not strangulated, incarcerated, or gangrenous) umbilical hernia repair as an isolated procedure (International Classification of Diseases, Ninth Revision procedure codes 53.41, 53.42, 53.43, or 53.49, International Classification of Diseases, Tenth Revision procedure code 0WQF0ZZ, or Current Procedural Terminology procedure codes 49580 or 49585). In all, 5212 children met criteria for inclusion. Children younger than age 2years accounted for 9.7% of repairs, with significant variation by census region (6% to 14%, P<.001). Total payments for surgery varied by age; children younger than 2years averaged $8219 and payments for older children were $6137. Postoperative admissions occurred at a rate of 73.1 per 1000 for children younger than age 2years and 7.43 for older children; emergency department visits were 41.5 per 1000 for children younger than age 2years vs 15.9 for older children (P<.001). Umbilical hernias continue to be repaired at early ages with large regional variation. Umbilical hernia repair younger than age 2years is associated with greater costs and greater frequency of postoperative hospitalization and emergency department visits.