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Erschienen in: Surgical Endoscopy 6/2010

01.06.2010

A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach

verfasst von: Marek Polomsky, Rui Hu, Boris Sepesi, Matthew O’Connor, Xing Qui, Daniel P. Raymond, Virginia R. Litle, Carolyn E. Jones, Thomas J. Watson, Jeffrey H. Peters

Erschienen in: Surgical Endoscopy | Ausgabe 6/2010

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Abstract

Background

Large-scale, population-based analyses of the demographics, management, and healthcare resource utilization of patients with an intrathoracic stomach are largely unknown, an issue which has become more important with the aging of the population. Our objective was to understand the magnitude of the problem and to assess clinical outcomes and hospital costs in elective and emergent admissions of patients with an intrathoracic stomach in a large population-based study.

Methods

The New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was queried for primary ICD-9-CM codes 553.3 and 552.3 in patients 18 years or older; 4858 hospital admissions were identified over a 5-year period (2002–2006). Database variables included age, gender, race, type of admission, operative intervention, in-hospital mortality, length of stay, and cost.

Results

Approximately 1000 patients are admitted to the hospital each year with primary diagnosis of intrathoracic stomach, an estimated 52 per 1 million of the population in New York State. Over half of those (53%) were emergent admissions. Interestingly, the majority of emergent admissions (66%) were discharged before any surgical intervention. Patients admitted emergently were older (68.0 vs. 62.1 years, p < 0.0001) and more likely African-American (12% vs. 6%, p < 0.0001). Compared to elective admissions, emergent admissions had higher mortality (2.7% vs. 1.2%, p < 0.001), longer length of stay (LOS) (7.3 vs. 4.9 days, p < 0.0001), and higher cost ($28,484 vs. $24,069, p < 0.001). Among patients who underwent surgery, emergent admissions had higher mortality (5.1% vs. 1.1%, p < 0.0001), greater LOS (13.1 vs. 4.9 days, p < 0.0001), and higher costs ($55,460 vs. $24,760, p < 0.0001). Multivariate regression analysis demonstrated age, emergent presentation, and operative admission as independent predictors for hospital mortality, LOS, and cost (p < 0.0001).

Conclusions

Strikingly, more than half of admissions for intrathoracic stomach were emergent. Emergent admissions had higher mortality, longer LOS, and higher cost than elective admissions. These data support consideration of early elective repair.
Literatur
1.
Zurück zum Zitat US Department of Health, Human Services, Centers for Disease Control, Prevention (2005) Trends in Health and Aging. USDHHS, Washington, DC US Department of Health, Human Services, Centers for Disease Control, Prevention (2005) Trends in Health and Aging. USDHHS, Washington, DC
2.
Zurück zum Zitat Lal DR, Pellegrini CA, Oelschlager BK (2005) Laparoscopic repair of paraesophageal hernia. Surg Clin North Am 85:105–118CrossRefPubMed Lal DR, Pellegrini CA, Oelschlager BK (2005) Laparoscopic repair of paraesophageal hernia. Surg Clin North Am 85:105–118CrossRefPubMed
3.
Zurück zum Zitat Low DE, Unger T (2005) Open repair of paraesophageal hernia: reassessment of subjective and objective outcomes. Ann Thorac Surg 80:287–294CrossRefPubMed Low DE, Unger T (2005) Open repair of paraesophageal hernia: reassessment of subjective and objective outcomes. Ann Thorac Surg 80:287–294CrossRefPubMed
4.
Zurück zum Zitat Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1, 030 patients. J Thorac Cardiovasc Surg 53:33–54PubMed Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1, 030 patients. J Thorac Cardiovasc Surg 53:33–54PubMed
5.
Zurück zum Zitat Hill LD (1973) Incarcerated paraesophageal hernia. A surgical emergency. Am J Surg 126:286–291CrossRefPubMed Hill LD (1973) Incarcerated paraesophageal hernia. A surgical emergency. Am J Surg 126:286–291CrossRefPubMed
6.
Zurück zum Zitat Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236:492–500; discussion 500-501CrossRefPubMed Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236:492–500; discussion 500-501CrossRefPubMed
7.
Zurück zum Zitat Poulose BK, Gosen C, Marks JM, Khaitan L, Rosen MJ, Onders RP, Trunzo JA, Ponsky JL (2008) Inpatient mortality analysis of paraesophageal hernia repair in octogenarians. J Gastrointest Surg 12:1888–1892CrossRefPubMed Poulose BK, Gosen C, Marks JM, Khaitan L, Rosen MJ, Onders RP, Trunzo JA, Ponsky JL (2008) Inpatient mortality analysis of paraesophageal hernia repair in octogenarians. J Gastrointest Surg 12:1888–1892CrossRefPubMed
8.
Zurück zum Zitat US Department of Health, Human Services, Centers for Disease Control, Prevention (2007) State and county quickfacts. USDHHS, Washington, DC US Department of Health, Human Services, Centers for Disease Control, Prevention (2007) State and county quickfacts. USDHHS, Washington, DC
9.
Zurück zum Zitat Hallissey MT, Ratliff DA, Temple JG (1992) Paraoesophageal hiatus hernia: surgery for all ages. Ann R Coll Surg Engl 74:23–25PubMed Hallissey MT, Ratliff DA, Temple JG (1992) Paraoesophageal hiatus hernia: surgery for all ages. Ann R Coll Surg Engl 74:23–25PubMed
10.
Zurück zum Zitat Treacy PJ, Jamieson GG (1987) An approach to the management of para-oesophageal hiatus hernias. Aust N Z J Surg 57:813–817CrossRefPubMed Treacy PJ, Jamieson GG (1987) An approach to the management of para-oesophageal hiatus hernias. Aust N Z J Surg 57:813–817CrossRefPubMed
11.
Zurück zum Zitat Allen MS, Trastek VF, Deschamps C, Pairolero PC (1993) Intrathoracic stomach. Presentation and results of operation. J Thorac Cardiovasc Surg 105:253–258PubMed Allen MS, Trastek VF, Deschamps C, Pairolero PC (1993) Intrathoracic stomach. Presentation and results of operation. J Thorac Cardiovasc Surg 105:253–258PubMed
12.
Zurück zum Zitat Altorki NK, Yankelevitz D, Skinner DB (1998) Massive hiatal hernias: the anatomic basis of repair. J Thorac Cardiovasc Surg 115:828–835; discussion 258-259CrossRefPubMed Altorki NK, Yankelevitz D, Skinner DB (1998) Massive hiatal hernias: the anatomic basis of repair. J Thorac Cardiovasc Surg 115:828–835; discussion 258-259CrossRefPubMed
13.
Zurück zum Zitat Geha AS, Massad MG, Snow NJ, Baue AE (2000) A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery 128:623–630CrossRefPubMed Geha AS, Massad MG, Snow NJ, Baue AE (2000) A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery 128:623–630CrossRefPubMed
14.
Zurück zum Zitat Sihvo EI, Salo JA, Rasanen JV, Rantanen TK (2009) Fatal complications of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg 137:419–424CrossRefPubMed Sihvo EI, Salo JA, Rasanen JV, Rantanen TK (2009) Fatal complications of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg 137:419–424CrossRefPubMed
Metadaten
Titel
A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach
verfasst von
Marek Polomsky
Rui Hu
Boris Sepesi
Matthew O’Connor
Xing Qui
Daniel P. Raymond
Virginia R. Litle
Carolyn E. Jones
Thomas J. Watson
Jeffrey H. Peters
Publikationsdatum
01.06.2010
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 6/2010
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-009-0755-1

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