Association of Sociodemographic Factors with Adherence to Age-specific Guidelines for Pediatric Umbilical Hernia Repair: A Nationwide Inpatient Sample Analysis

Abstract

Background: Age-specific recommendations generally support observation of uncomplicated paediatric umbilical hernias because many close spontaneously during early childhood. Nevertheless, some children undergo repair earlier than recommended, and the demographic, clinical, and institutional factors associated with this timing remain incompletely characterised. Aim: This study examined factors associated with umbilical hernia repair at 3 years of age or younger. Methods: A retrospective cohort analysis was conducted using the 2023 Nationwide Inpatient Sample. Children aged 0–17 years who underwent umbilical hernia repair were identified using APR-DRG 228. Early repair was defined as surgery at 3 years of age or younger. Demographic, payer, admission, and severity variables were evaluated, and independent associations were estimated using multivariable logistic regression. Results: Of 5,806 identified children, 5,512 met the study criteria, and 581 underwent early repair. Early repair was associated with residence in the lowest income quartile (adjusted odds ratio [aOR] = 1.87; 95% confidence interval [CI]: 1.45–2.41), Medicaid coverage (aOR = 1.62; 95% CI: 1.28–2.05), non-elective admission (aOR = 2.14; 95% CI: 1.69–2.71), and major or extreme illness severity (aOR = 1.93 and 2.67, respectively). Conclusion: Early inpatient repair was associated with socioeconomic disadvantage, clinical urgency, and greater illness severity. These associations should be interpreted cautiously because administrative data do not establish the reasons for surgical timing or the clinical appropriateness of individual procedures.