Low Detection Rate of Possible Anesthesia-Related Complications After Pediatric Inguinal Hernia Repair Challenges Current Postoperative Monitoring Protocols

<b>Background</b>: Inguinal hernia repair (IHR) is frequently performed in infants, often under general anesthesia. Preterm infants are routinely monitored for 24 h postoperatively, due to high reported rates of respiratory complications. However, recent data suggest a decline in these events, prompting a reevaluation of the existing monitoring protocols. This study assesses the detection of (possible) anesthesia-related complications within 24 h after IHR in infants under 3 months of age and aims to identify risk factors for these complications. <b>Methods</b>: This retrospective cohort study included consecutive patients aged ≤ 3 months who underwent IHR between November 2015 and August 2023. All underwent IHR under general anesthesia. Subjects were compared based on whether they experienced possible anesthesia-related complications within 24 h after surgery or not. A logistic regression model was constructed and the number needed to monitor was calculated. <b>Results</b>: 306 patients were included, of which 36.3% were prematurely born (gestational age < 37 weeks) and the mean postconceptional age at surgery was 47.7 ± 4.8 weeks. Possible anesthesia-related complications were detected in 10 patients (3.3%), but only 8 (2.6%) were likely attributable to anesthesia. Events included desaturations, convulsions, fever, and a choking incident. Significant differences were found in patients experiencing complications when they had pre-existing respiratory (<i>p</i> = 0.013) or circulatory (<i>p</i> = 0.016) comorbidities. The postconceptional age (PCA) and gestational age (GA) were not significantly different between groups. Univariate logistic regression did not show a significant correlation between anesthesia-related complications and PCA or GA. <b>Conclusions</b>: Our data corroborates the suggestion that prematurity and PCA alone are not the main characteristics upon which postoperative monitoring protocols should be based. We hypothesize that an individualized approach based on comorbidities and clinical history could be more accurate. These findings point toward the necessity of more (prospective) research to support the refinement of postoperative monitoring guidelines to optimize healthcare resource allocation, while maintaining patient safety.