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Emergent Surgery Does Not Independently Predict 30-Day Mortality After Paraesophageal Hernia Repair: Results from the ACS NSQIP Database

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Aim

Patients undergoing emergency surgery for paraesophageal hernia (PEH) repair have a higher adjusted mortality risk based on Nationwide Inpatient Sample (NIS). We sought to examine this relationship in the National Surgical Quality Improvement Program (NSQIP), which adjusts for patient-level risk factors, including factors contributing to patient frailty.

Methods

This is a retrospective analysis of the NSQIP from 2009 through 2011. A modified frailty index was created based on previously validated methodology.

Results

Of 3498 patients with PEH repair, 175 (5 %) underwent emergent surgery. Older age, lower BMI, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), current dialysis, SIRS, and sepsis were significantly more common among emergent patients. These patients also had a poorer functional status, higher American Society of Anesthesiologists (ASA), and higher frailty scores and more likely to undergo open surgery. Postoperative complications were proportionally more common, and LOS was longer (8.5 vs. 3.4 days) among emergent patients (all p < 0.05). In univariate analysis, emergent patients demonstrated ten times greater mortality than the elective surgery group (8 vs. 0.8 %). On adjusted analysis, emergent surgery was no longer independently associated with mortality. Frailty score 2 or above and preoperative sepsis significantly predicted increased mortality while laparoscopic repair and BMI 25–50 and BMI ≥30 (vs. BMI <18.5) were significantly protective in the entire group of patients.

Conclusion

Increased mortality among patients undergoing emergent PEH repair may be related to severity of disease and other preoperative comorbid illness. Without an emergent indication, some of these patients likely would have been excluded as candidates for elective surgical intervention.

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Authors and Affiliations

  1. Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA

    Toms Augustin, Eric Schneider, Diya Alaedeen, Matthew Kroh, Ali Aminian, David Reznick, Matthew Walsh & Stacy Brethauer

  2. The Johns Hopkins School of Medicine, Baltimore, MD, USA

    Toms Augustin, Eric Schneider, Diya Alaedeen, Matthew Kroh, Ali Aminian, David Reznick, Matthew Walsh & Stacy Brethauer

Authors
  1. Toms Augustin
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  2. Eric Schneider
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  3. Diya Alaedeen
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  4. Matthew Kroh
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  5. Ali Aminian
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  7. Matthew Walsh
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  8. Stacy Brethauer
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Correspondence to Toms Augustin.

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Augustin, T., Schneider, E., Alaedeen, D. et al. Emergent Surgery Does Not Independently Predict 30-Day Mortality After Paraesophageal Hernia Repair: Results from the ACS NSQIP Database. J Gastrointest Surg 19, 2097–2104 (2015). https://doi.org/10.1007/s11605-015-2968-z

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  • DOI: https://doi.org/10.1007/s11605-015-2968-z

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