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

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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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Authors and Affiliations

  1. Department of Surgery, University Hospital, Spitalstr. 21, 4031, Basel, Switzerland

    Hannes J. Larusson, Urs Zingg, Karen Delport & Daniel Oertli

  2. Department of Visceral and Transplantation Surgery, University Hospital, Rämistr. 100, 8091, Zurich, Switzerland

    Dieter Hahnloser

  3. Biostatistics Unit, ISPM, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland

    Burkhardt Seifert

Authors
  1. Hannes J. Larusson
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  2. Urs Zingg
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  3. Dieter Hahnloser
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  4. Karen Delport
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  5. Burkhardt Seifert
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  6. Daniel Oertli
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Corresponding author

Correspondence to Urs Zingg.

Additional information

H. J. Larusson and U. Zingg equally contributed as first authors.

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Larusson, H.J., Zingg, U., Hahnloser, D. et al. Predictive Factors for Morbidity and Mortality in Patients Undergoing Laparoscopic Paraesophageal Hernia Repair: Age, ASA Score and Operation Type Influence Morbidity. World J Surg 33, 980–985 (2009). https://doi.org/10.1007/s00268-009-9958-9

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  • DOI: https://doi.org/10.1007/s00268-009-9958-9

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