National Practice Variation and Disparities in Pediatric Umbilical Hernia Repair Under Five

Objective: This study aimed to assess national trends and predictors of elective pediatric umbilical hernia repair (UHR) before and after age 5. Background: Limited surgical guidelines exist for pediatric umbilical hernias, leading to variations in practice patterns and timing of elective UHR. Methods: The Nationwide Ambulatory Surgery Sample (2016–2022) was used to identify isolated elective repairs of reducible umbilical hernias. Patients were categorized into early (0–4 y) and delayed (5–9 y) cohorts. Descriptive statistics and sample-weighted regression models were used to assess patient and hospital factors associated with delayed UHR. Outcome measures were total charge and nonhome discharges. Age-adjusted and sex-adjusted national incidences were determined using negative binomial regression. Results: Among 75,943 patients, the early (47.6%) and delayed (52.3%) cohorts had comparable case volumes. Early UHR was associated with higher total costs ($13,594 vs $13,141) and nonhome discharges (0.2% vs 0.1%). The incidence of delayed UHR compared with that of early UHR increased after 2021. The incidence and odds of delayed UHR varied in the United States by region. Multivariate regression identified female sex, rural residence, nonprivate payment, and urban hospital location as factors with lower odds of delayed repair, while income above the 50th percentile and later years (2021-2022) were associated with higher odds of delayed repair. Conclusions: Nearly half of elective UHR occurred before age 5, with increased health care utilization and nonroutine discharge. Significant socioeconomic and regional disparities highlight the need for standardized surgical guidelines to address the variability in pediatric umbilical hernia management.