Postdischarge Emergency Research Articles

Outpatient inguinal herniorrhaphy in premature infants: Is it safe?

Because postoperative apnea and bradycardia in premature infants following inguinal herniorrhaphy remains a concern, outpatient repair has not been recommended. We have been performing outpatient inguinal herniorrhaphy in premature infants and the present study reviews our experience. Between 1985 and 1990, 1,294 outpatient inguinal herniorrhaphies were performed. Of this group 124 patients (9.6%) were identified as being premature (≤ 36 weeks gestational age). Average ages were: gestational age 32.7 weeks (range, 24 to 36 weeks); postnatal age 12.6 weeks (range, 3 to 24 weeks); and postconceptional age (gestational plus postnatal) 45.3 weeks (range, 34 to 59 weeks). Twenty-two infants previously required ventilatory support, 11 patients had apnea/bradycardia, and 9 patients developed bronchopulmonary dysplasia. General anesthesia (usually nitrous oxide and fluothane) was used in all patients and 75% underwent endotracheal intubation. The average operating room time was 40 minutes (range, 20 to 115 minutes) and the average recovery room time was 94 minutes (range, 30 to 240 minutes). There were no periperative deaths. One patient became apneic immediately after extubation in the operating room. No further episodes were noted after 4 hours of observation. Another patient following discharge had a brief apneic episode at home while on an apnea monitor, which was relieved with gentle stimulation. Both patients had no further sequelae. Bradycardia to 80 beats/min was noted in two patients, and resolved spontaneously in the recovery room. Laryngospasm after extubation in the operating room occurred in two patients, one of whom required brief reintubation and the other resolved spontaneously. Two patients required postoperative ventilation: one was extubated in the recovery room and the other was hospitalized for 24 hours. This series did not demonstrate the high postoperative incidence of apnea and bradycardia as previously reported. This was true even for those infants with a prior history of apnea and bradycardia. Although the reasons for the decreased incidence of apnea/bradycardia are unclear, it is important to note that preoperative and intraoperative narcotics were not used and muscle relaxation was infrequently used (14%). There was only one postdischarge emergency room visit and no patients required admission following discharge from the outpatient surgery center. On the basis of our experience, routine inpatient inguinal herniorrhaphy in infants born prematurely does not appear to be necessary. Outpatient inguinal herniorrhaphy can be performed in this patient group with minimal morbidity and no mortality.