Predictors of Morbidity and Mortality in Complex Paraesophageal Hernia Repair: A NSQIP Analysis

Abstract

Paraesophageal hernia (PEH) repair is typically performed electively. Complex PEHs (obstructed or gangrenous) require more urgent repair and can have significant complications. Although elective repair is primarily laparoscopic, limited data are available on the use of laparoscopy for complex cases. Patients undergoing complex PEH repair were identified from the NSQIP database, and predictors of morbidity and mortality were compared for 2473 laparoscopic and 861 open repairs. Compared with the laparoscopic approach, emergent surgeries (36.7% vs 10.8%, P < 0.001) and preoperative sepsis (22.9% vs 7.4%, P < 0.001) were more common in the open group. Operative times were shorter for open repairs (152.6 vs 172.2 minutes, P = 0.03). However, open repair was associated with increased morbidity (28.2% vs 11%, P < 0.001) and mortality (5.2% vs 1.4%, P < 0.001), likely because of higher rates of preoperative comorbidities in the open group. On multivariable regression analysis, preoperative sepsis was associated with increased mortality and morbidity, whereas laparoscopic repair was associated with decreased morbidity. If laparoscopic repair can be safely completed, it is associated with decreased morbidity, despite longer operative times.

Elective Laparoscopic Paraesophageal Hernia Repair leads to an Increase in Life-Expectancy over Watchful Waiting in Asymptomatic Patients

“…Age impacts emergent surgical mortality as it does for ELHR, and we stratified mortality by age groups. Major complications were considered to occur in 22% of patients with a 6% reoperation rate 15,30 . Values used for the variables related to emergent PEH surgical intervention are shown in Table 4.…”

“…Major complications were considered to occur in 22% of patients with a 6% reoperation rate. 15,30 Values used for the variables related to emergent PEH surgical intervention are shown in Table 4.…”