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A population-based analysis of emergent versus elective paraesophageal hernia repair using the Nationwide Inpatient Sample. Surg Endosc 2014 Dec;28(12):3473-8 PMID: 24939163 PMCID: PMC4422062

Pubmed ID

24939163

Abstract

BACKGROUND: As the life expectancy in the United States continues to increase, more elderly, sometimes frail patients present with sub-acute surgical conditions such as a symptomatic paraesophageal hernia (PEH). While the outcomes of PEH repair have improved largely due to the proliferation of laparoscopic surgery, there is still a defined rate of morbidity and mortality. We sought to characterize the outcomes of both elective and emergent PEH repair using a large population-based data set.

METHODS: The Nationwide Inpatient Sample was queried for primary ICD-9 codes associated with PEH repair (years 2006-2008). Outcomes were in-hospital mortality and the occurrence of a pre-identified complication. Multivariate analysis was performed to determine the risk factors for complications and mortality following both elective and emergent PEH repair.

RESULTS: A total of 8,462 records in the data, representing 41,723 patients in the US undergoing PEH repair in the study interval, were identified. Of these procedures, 74.2% was elective and 42.4% was laparoscopic. The overall complication and mortality rates were 20.8 and 1.1%, respectively. Emergent repair was associated with a higher rate of morbidity (33.4 vs. 16.5%, p < 0.001) and mortality (3.2 vs. 0.37%, p < 0.001) than elective repair. Emergent repair patients were more likely to be male, were older, and more likely to be minority. Logistic modeling revealed that younger age, elective case status, and a laparoscopic approach were independently associated with a lower probability of complications and mortality.

CONCLUSIONS: Patients undergoing emergent PEH repair in the United States tend to be older, more likely a racial minority, and less likely to undergo laparoscopic repair. Elective repair, younger age, and a laparoscopic approach are associated with improved outcomes. Considering all of the above, we recommend that patients consider elective repair with a surgeon experienced in the laparoscopic approach, especially when symptoms related to the hernia are present.

Author List

Jassim H, Seligman JT, Frelich M, Goldblatt M, Kastenmeier A, Wallace J, Zhao HS, Szabo A, Gould JC

Authors

Matthew I. Goldblatt MD Professor in the Surgery department at Medical College of Wisconsin
Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Andrew Sean Kastenmeier MD Associate Professor in the Surgery department at Medical College of Wisconsin
Aniko Szabo PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-84939891889   19 Citations

MESH terms used to index this publication - Major topics in bold

Aged
Elective Surgical Procedures
Emergencies
Female
Hernia, Hiatal
Herniorrhaphy
Hospital Mortality
Humans
Inpatients
Laparoscopy
Male
Middle Aged
Morbidity
Population Surveillance
Postoperative Complications
Retrospective Studies
Risk Factors
United States
jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6