Association of Surgery Delay Related to SARS-CoV-2 with Complications among Pediatric Patients with Inguinal Hernia

Hu, Andrew J.; Reiter, Audra; Gerardo, Rodrigo; Skertich, Nicholas J.; Witte, Amanda; Kang, Hae-Sung; Richards, Holden; Perry, Bradley P.; Abdul Ghani, Muhammad Owais; Raval, Mehul V.

Introduction: During the peak of the SARS-CoV-2 pandemic, several elective surgical procedures were strategically delayed. The purpose of this study was to determine whether delays in elective pediatric inguinal hernia repair were associated with complications. Methods: We performed a multicenter retrospective cohort study at 14 children’s hospitals in the US comparing patients 18 years and younger undergoing inguinal hernia repair during a 6-month period before and after the SARS-CoV-2 pandemic elective surgical procedure restriction. Patient demographics, interval healthcare utilization, incarceration rates, and operative characteristics were collected. Fisher exact, Wilcoxon rank-sum, and chi-square statistical tests were used for comparison. Results: Of 1,598 patients included in the study, 772 (48.3%) received their operation after elective surgical restrictions, 1,248 (78.1%) were male, and 716 (44.8%) were diagnosed at younger than 1 year. After initiation of restrictions, patients had significantly more days between diagnosis and operation (Fig. 1), but no significant difference in the rate of incarceration (pre 7.64% vs post 5.81%;p = 0.14). There was no significant difference in the median number of days from diagnosis to incarceration (pre 17.5;interquartile range 9 to 64 vs post 24;interquartile range 5 to 71;p = 0.83). After restrictions, diagnosis was more frequently performed via telehealth (pre 0.12% vs post 6.09%) and in the emergency department (pre 9.7% vs post 13.9%;overall p < 0.01). Conclusion: Delays in elective surgery due to the SARS-CoV-2 pandemic were not associated with inguinal hernia complications, but were associated with an increase in diagnosis through telemedicine and emergency department encounters. [Formula presented]