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World Journal of Surgery

Published in:

01-05-2009

Predictive Factors for Morbidity and Mortality in Patients Undergoing Laparoscopic Paraesophageal Hernia Repair: Age, ASA Score and Operation Type Influence Morbidity

Authors: Hannes J. Larusson, Urs Zingg, Dieter Hahnloser, Karen Delport, Burkhardt Seifert, Daniel Oertli

Published in: World Journal of Surgery | Issue 5/2009

Abstract

Background

Patients undergoing laparoscopic paraesophageal hernia (PEH) repair risk substantial morbidity. The aim of the present study was to analyze predictive factors for postoperative morbidity and mortality.

Methods

A total of 354 laparoscopic PEH repairs were analyzed from the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS). Age (<70 and ≥70 years) and risk (low: American Society of Anesthesiologists (ASA) scores 1 + 2; high ASA scores 3 + 4) groups were defined and multivariate logistic regression was conducted.

Results

In patients ≥70 years of age postoperative morbidity (24.4% versus 10.1%; p = 0.001) and mortality (2.4% versus 0%; p = 0.045) were significantly higher than in patients <70 years of age. In patients with gastropexy, this significant age difference was again present (38.8% versus 10.5%; p = 0.001) whereas in patients with fundoplication no difference between age groups occurred (11.9% versus 10.1%; p = 0.65). Mortality did not differ. High-risk patients had a significantly higher morbidity (26.0% versus 11.2%; p = 0.001) but not mortality (2.1% versus 0.4%; p = 0.18). The multivariate logistic regression identified the following variables as influencing postoperative morbidity: Age ≥70 years (Odds Ratio [OR] 1.99 [95% CI 1.06 to 3.74], p = 0.033); ASA 3 + 4 (OR 2.29 [95% Confidence Interval (CI) 1.22 to 4.3]; p = 0.010); type of operation (gastropexy) (OR 2.36 [95% CI 1.27 to 4.37]; p = 0.006).

Conclusions

In patients undergoing laparoscopic paraesophageal hernia repair age, ASA score, and type of operation significantly influence postoperative morbidity and mortality. Morbidity is substantial among elderly patients and those with co-morbidity, questioning the paradigm for surgery in all patients. The indication for surgery must be carefully balanced against the individual patient’s co-morbidities, age, and symptoms, and the potentially life threatening complications.

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Title: Predictive Factors for Morbidity and Mortality in Patients Undergoing Laparoscopic Paraesophageal Hernia Repair: Age, ASA Score and Operation Type Influence Morbidity
Authors: Hannes J. Larusson
Urs Zingg
Dieter Hahnloser
Karen Delport
Burkhardt Seifert
Daniel Oertli
Publication date: 01-05-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 5/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-009-9958-9

At a glance: The STEP trials

Springer Medicine

Predictive Factors for Morbidity and Mortality in Patients Undergoing Laparoscopic Paraesophageal Hernia Repair: Age, ASA Score and Operation Type Influence Morbidity

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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