Variation in the use of laparoscopy with inguinal hernia repairs in a sample of pediatric patients at children's hospitals

Variation existed in the use of laparoscopy during inguinal hernia repairs and associated costs within the current sample from children's hospitals in the United States. The additional costs of laparoscopic evaluation must be considered against the clinical utility and therapeutic consequences of identifying individuals with a higher risk of metachronous contralateral inguinal hernia.Summary Table. Characteristics of population and proportion, and cost of hernia repairs with and without diagnostic laparoscopy.CharacteristicTotal (n = 3.952)Hernia without laparoscopy (n = 3.515)Hernia with diagnostic laparoscopy (n = 437)Laterality: Unilateral3375 (85.4)3033 (86.3)342 (78.3) Bilateral577 (14.6)482 (13.7)95 (21.7)Age, years: Median (IQR)4 (1-7)4 (1-7)2 (0-5) <1665 (16.8)542 (15.4)123 (28.1) 1-2917 (23.2)815 (23.2)102 (23.3) 3-51034 (26.2)925 (26.3)109 (24.9) 6-11869 (22.0)784 (22.3)85 (19.5) 12-18467 (11.8)449 (12.8)18 (4.1)Gender: Male3115 (78.8)2807 (79.9)308 (70.5) Female837 (21.2)708 (20.1)129 (29.5)Race/Ethnicity: Caucasian2565 (64.9)2264 (64.4)301 (68.9) Black658 (16.6)586 (16.7)72 (16.5) Other587 (14.9)543 (15.4)44 (10.1) Missing142 (3.6)122 (3.5)20 (4.6) Hispanic592 (15.0)544 (15.5)48 (11.0)Payer type: Public1849 (46.8)1658 (47.2)191 (43.7) Private1934 (48.9)1697 (48.3)237 (54.2) Self/other169 (4.3)160 (4.5)9 (2.1)Surgeon type: Pediatric surgeon2766 (70.0)2387 (67.9)379 (86.7) Pediatric urologist1186 (30.0)1128 (32.1)58 (13.3)Adjusted cost:$2395 ($1735-3071)$2363 ($1718-3024)$2735 ($1990-3425)Table given as median (IQR) or n (%).