The Impact of Age and Need for Emergent Surgery in Paraesophageal Hernia Repair Outcomes. The Annals of thoracic surgery Wong, L. Y., Parsons, N., David, E. A., Burfeind, W., Berry, M. F. 2023


Observation of paraesophageal hernias (PEH) may lead to emergent surgery for hernia-related complications. This study evaluated urgent/emergent repair outcomes to quantify the possible sequelae of failed conservative PEH management.The impact of operative status (Elective vs. Urgent/Emergent) on perioperative mortality or major morbidity for patients who underwent hiatal hernia repair for a paraesophageal hernia diagnosis from 2012-2021 in the Society of Thoracic Surgery General Thoracic Surgery Database was evaluated with multivariable logistic regression models.Overall, 2,082 (10.9%) of 19,122 PEH patients underwent Urgent/Emergent repair. Non-elective surgery patients were significantly older than elective surgery patients (median age 73 years [IQR 63-82] versus 66 [58-74]) and had a lower preoperative performance score (p<0.001). Non-elective surgeries were more likely to be done through the chest or via laparotomy rather than via laparoscopy (20% versus 11.4%, p<0.001) and were associated with longer hospitalizations (4 days vs 2, p<0.001), higher operative mortality (4.5% vs 0.6%, p<0.001), and higher major morbidity (27% versus 5.5%, p<0.001). Non-elective surgery was a significant independent predictor of major morbidity in multivariable analysis (odds ratio 2.06, p<0.001). Patients over the age of 80 had higher operative mortality (4.3% vs 0.6%, p<0.001) and major morbidity (19% vs 6.1%, p<0.001) than younger patients overall, and more often had non-elective surgery (26% vs 8.6%, p<0.001) CONCLUSIONS: The operative morbidity of PEH repair is significantly increased when surgery is non-elective, particularly for older patients. These results can inform the potential consequences of choosing watchful waiting versus elective PEH repair.

View details for DOI 10.1016/j.athoracsur.2023.01.017

View details for PubMedID 36702291