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01.12.2014 | Ausgabe 12/2014

Surgical Endoscopy 12/2014

A population-based analysis of emergent versus elective paraesophageal hernia repair using the Nationwide Inpatient Sample

Zeitschrift:
Surgical Endoscopy > Ausgabe 12/2014
Autoren:
Hassanain Jassim, Johnathan T. Seligman, Matthew Frelich, Matthew Goldblatt, Andrew Kastenmeier, James Wallace, Heather S. Zhao, Aniko Szabo, Jon C. Gould
Wichtige Hinweise
Presented as a Poster at the 2013 Annual SAGES meeting, Baltimore, MD.

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.

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