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Surgical Endoscopy

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01-07-2021 | Minimally Invasive Surgery

Non-elective paraesophageal hernia repair: surgical approaches and short-term outcomes

Authors: William Sherrill III, Isolina Rossi, Michael Genz, Brent D. Matthews, Caroline E. Reinke

Published in: Surgical Endoscopy | Issue 7/2021

Abstract

Background

The majority of laparoscopic paraesophageal hernia (PEH) repairs are performed electively. We aimed to investigate the frequency of non-elective laparoscopic (MIS) PEH repair and compare 30-day outcomes to elective MIS repairs and non-elective open repairs. We hypothesized that an increasing percentage of non-elective PEH repairs would be performed laparoscopically and that this population would have improved outcomes compared to non-elective open PEH counterparts.

Methods

The 2011–2016 NSQIP PUFs were used to identify patients who underwent PEH repair. Case status was classified as open vs. MIS and elective versus non-elective. Preoperative patient characteristics, operative details, discharge destination, and 30-day postoperative complication rates were compared. Logistic regression was used to examine the impact of case status on 30-day mortality.

Results

We identified 20,010 patients who underwent PEH. There were an increasing number of MIS PEH repairs in NSQIP between 2011 and 2016. Non-elective repairs were performed in 2,173 patients and 73.4% of these were completed laparoscopically. Elective MIS patients were younger, had a higher BMI, and were more likely to be functionally independent (p < 0.01) than their non-elective counterparts. Non-elective MIS patients had a higher wound class and ASA class compared to their elective counterparts. Compared to elective MIS cases, non-elective MIS PEH repair was associated with increased odds of mortality, even after controlling for patient characteristics (OR = 1.76, p = 0.02). There was no statistically significant difference in mortality for non-elective MIS vs. non-elective open PEH repair. There is an increase in non-elective PEH repairs recorded in NSQIP over time studied.

Conclusions

The population undergoing non-elective MIS PEH repairs is different from their elective MIS counterparts and experience a higher postoperative mortality rate. While the observed increased utilization of MIS techniques in non-elective PEH repairs likely provides benefits for the patient, there remain differences in outcomes for these patients compared to elective PEH repairs.

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Title: Non-elective paraesophageal hernia repair: surgical approaches and short-term outcomes
Authors: William Sherrill III
Isolina Rossi
Michael Genz
Brent D. Matthews
Caroline E. Reinke
Publication date: 01-07-2021
Publisher: Springer US
Keyword: Minimally Invasive Surgery
Published in: Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07782-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-elective paraesophageal hernia repair: surgical approaches and short-term outcomes

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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