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26-07-2023 | 2023 SAGES Oral

Defining surgical risk in octogenarians undergoing paraesophageal hernia repair

Authors: Hadley H. Wilson, Sullivan A. Ayuso, Mikayla Rose, Dau Ku, Gregory T. Scarola, Vedra A. Augenstein, Paul D. Colavita, B. Todd Heniford

Published in: Surgical Endoscopy | Issue 11/2023

Abstract

Background

With an aging population, the utility of surgery in elderly patients, particularly octogenarians, is of increasing interest. The goal of this study was to analyze outcomes of octogenarians versus non-octogenarians undergoing paraesophageal hernia repair (PEHR).

Methods

The Nationwide Readmission Database was queried for patients > 18 years old who underwent PEHR from 2016 to 2018. Exclusion criteria included a diagnosis of gastrointestinal malignancy or a concurrent bariatric procedure. Patients ≥ 80 were compared to those 18–79 years old using standard statistical methods, and subgroup analyses of elective and non-elective PEHRs were performed.

Results

From 2016 to 2018, 46,450 patients were identified with 5425 (11.7%) octogenarians and 41,025 (88.3%) non-octogenarians. Octogenarians were more likely to have a non-elective operation (46.3% vs 18.2%, p < 0.001), and those undergoing non-elective PEHR had a higher mortality (5.5% vs 1.2%, p < 0.001). Outcomes were improved with elective PEHR, but octogenarians still had higher mortality (1.3% vs 0.2%, p < 0.001), longer LOS (3[2, 5] vs 2[1, 3] days, p < 0.001), and higher readmission rates within 30 days (11.1% vs 6.5%, p < 0.001) compared to non-octogenarian elective patients. Multivariable logistic regression showed that being an octogenarian was not independently predictive of mortality (odds ratio (OR) 1.373[95% confidence interval 0.962–1.959], p = 0.081), but a non-elective operation was (OR 3.180[2.492–4.057], p < 0.001). Being an octogenarian was a risk factor for readmission within 30 days (OR 1.512[1.348–1.697], p < 0.001).

Conclusions

Octogenarians represented a substantial proportion of patients undergoing PEHR and were more likely to undergo a non-elective operation. Being an octogenarian was not an independent predictor of perioperative mortality, but a non-elective operation was. Octogenarians' morbidity and mortality was reduced in elective procedures but was still higher than non-octogenarians. Elective PEHR in octogenarians is reasonable but should involve a thorough risk–benefit analysis.

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Title: Defining surgical risk in octogenarians undergoing paraesophageal hernia repair
Authors: Hadley H. Wilson
Sullivan A. Ayuso
Mikayla Rose
Dau Ku
Gregory T. Scarola
Vedra A. Augenstein
Paul D. Colavita
B. Todd Heniford
Publication date: 26-07-2023
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10270-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Defining surgical risk in octogenarians undergoing paraesophageal hernia repair

Abstract

Background

Methods

Results

Conclusions

Visual abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Visual abstract

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