Outcome of laparoscopic paraesophageal hernia repair in octogenarians: a registry-based, propensity score-matched comparison of 360 patients

Abstract

Background Paraesophageal hernias (PEH) tend to occur in elderly patients and the assumed higher morbidity of PEH repair may dissuade clinicians from seeking a surgical solution. On the other hand, the mortality rate for emergency repairs shows a sevenfold increase compared to elective repairs. This analysis evaluates the complication rates after elective PEH repair in patients 80 years and older in comparison with younger patients. Methods In total, 3209 patients with PEH were recorded in the Herniamed Registry between September 1, 2009 and January 5, 2018. Using propensity score matching, 360 matched pairs were formed for comparative analysis of general, intraoperative, and postoperative complication rates in both groups. Results Our analysis revealed a disadvantage in general complications (6.7% vs. 14.2%; p = 0.002) for patients ≥ 80 years old. No significant differences were found between the two groups for intraoperative (4.7% vs. 5.8%, p = 0.627) and postoperative complications (2.2% vs. 2.8%, p = 0.815) or for complication-related reoperations (1.7% vs. 2.2%, p = 0.791). Conclusions Despite a higher risk of general complications, PEH repair in octogenarians is not in itself associated with increased rates of intraoperative and postoperative complications or associated reoperations. Therefore, PEH repair can be safely offered to elderly patients with symptomatic PEH, if general medical risk factors are controlled. Electronic supplementary material The online version of this article (10.1007/s00464-018-06619-4) contains supplementary material, which is available to authorized users.

Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients

“…“The Herniamed quality assurance study is a multicenter internet-based hernia registry with voluntary participating institutions which incorporate prospective data of patients who have undergone routine hernia surgery” [ 20 , 21 ].…”

“…“These data are obtained from 712 voluntarily participating hospitals and surgeons in Germany, Austria, and Switzerland” [ 20 , 21 ]. All patients gave informed consent agreeing to participate [ 20 , 21 ].…”

“…“These data are obtained from 712 voluntarily participating hospitals and surgeons in Germany, Austria, and Switzerland” [ 20 , 21 ]. All patients gave informed consent agreeing to participate [ 20 , 21 ]. “As part of the informed consent declaration, information provided to patients regarding participation in the Herniamed Registry included the request that the hospital or medical practice providing treatment would like to be informed about any problem occurring after the operation and that patients have the opportunity to attend clinical examination” [ 20 , 21 ].…”

“…“At 1-year follow-up, postoperative complications are once again reviewed when the general practitioner and patient are asked to report any occurrences, pain at rest, pain on exertion, and chronic pain requiring treatment” [ 20 , 21 ]. “If recurrence or chronic pain is reported by the patient or the general practitioner the patients can be requested to present themselves for clinical or radiological examination” [ 20 , 21 ]. A publication by Baucom et al [ 22 ] has provided impressive evidence of the role of patient-reported outcomes for both recurrence and chronic pain following incisional hernia repair.…”

Laparoscopic Paraesophageal Hernia Repair and Pulmonary Embolism

“…15 In other studies, propensity scoring and matched sampling techniques have been used to adjust for age and comorbidities, and have found that age alone did not correspond with increased complications or that nonelective repair was the primary risk factor. 16,17 Age may not be the true risk factor for PEHR, but rather acuity and comorbidities. Frailty may become a better-combined marker to predict complication risk as suggested by a study by Augustin et al, 8 and may warrant further study.…”