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Morbidity and mortality associated with antireflux surgery with or without paraesophogeal hernia: a large ACS NSQIP analysis

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Abstract

Background

Surgical repair of paraesophageal hernias (PEH) represents a considerable technical challenge in patients who are older and have multiple comorbidities. We sought to identify factors associated with increased rates of mortality and morbidity in these patients.

Methods

We performed a retrospective analysis of the National Surgical Quality Improvement Program from 2005 through 2007. Patients who underwent an antireflux operation or repair of PEH and with a primary diagnosis of PEH or GERD were included. Primary outcome was 30-day mortality. Secondary outcomes included intraoperative blood transfusion (BT) and standard comorbidities. Multivariate analyses were performed, adjusting for factors of age and BMI.

Results

A total of 3518 patients were identified, including 1290 PEH patients. Compared to GERD patients, PEH patients were significantly older and had more comorbidities. On adjusted analysis for PEH patients only, BT and age ≥70 years were significantly associated with multiple outcome variables, including pulmonary complications and venous thromboembolism (VTE), but had no association with mortality. BMI was not found to be associated with any of our outcome measures.

Conclusion

Despite higher rates of complications, notably pulmonary and VTE, PEH can be repaired in the elderly with mortality rates comparable to those in younger populations. BMI does not adversely impact any short-term outcome measures in patients undergoing PEH repair.

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References

  1. Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7:59–66

    Article  PubMed  Google Scholar 

  2. Gangopadhyay N, Perrone JM, Soper NJ, Matthews BD, Eagon JC, Klingensmith ME, Frisella MM, Brunt LM (2006) Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients. Surgery 140:491–498

    Article  PubMed  Google Scholar 

  3. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236:492–500

    Article  PubMed  Google Scholar 

  4. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190:553–560

    Article  PubMed  CAS  Google Scholar 

  5. Davis SS Jr (2008) Current controversies in paraesophageal hernia repair. Surg Clin North Am 88:959–978

    Article  PubMed  Google Scholar 

  6. Draaisma WA, Gooszen HG, Tournoij E, Broeders IA (2005) Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc 19:1300–1308

    Article  PubMed  CAS  Google Scholar 

  7. Gupta A, Chang D, Steele KE, Schweitzer MA, Lyn-Sue J, Lidor AO (2008) Looking beyond age and co-morbidities as predictors of outcomes in paraesophageal hernia repair. J Gastrointest Surg 12:2119–2124

    Article  PubMed  Google Scholar 

  8. American College of Surgeons National Surgical Quality Improvement Program. https://acsnsqip.org/login/default.aspx. Accessed July 21, 2009

  9. User Guide for the 2007 Participant Use Data File American College of Surgeons National Surgical Quality Improvement Program. https://acsnsqip.org/puf/docs/ACS_NSQIP_Participant_User_Data_File_User_Guide.pdf. Accessed July 21, 2009

  10. ACS NSQIP Data Collection Overview. Available at https://acsnsqip.org/main/program_data_collection.asp. Accessed July 21, 2009

  11. Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17:864–867

    Article  PubMed  CAS  Google Scholar 

  12. Trus TL, Bax T, Richardson WS, Branum GD, Mauren SJ, Swanstrom LL, Hunter JG (1997) Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1:221–227

    Article  PubMed  CAS  Google Scholar 

  13. Dahlberg PS, Deschamps C, Miller DL, Allen MS, Nichols FC, Pairolero PC (2001) Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 72:1125–1129

    Article  PubMed  CAS  Google Scholar 

  14. Luketich JD, Nason KS, Christie NA, Pennathur A, Jobe BA, Landreneau RJ, Schuchert MJ (2010) Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 139:395–404

    Article  PubMed  Google Scholar 

  15. Larusson HJ, Zingg U, Hahnloser D, Delport K, Seifert B, Oertli D (2009) 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

    Article  PubMed  Google Scholar 

  16. Hazebroek EJ, Gananadha S, Koak Y, Berry H, Leibman S, Smith GS (2008) Laparoscopic paraesophageal hernia repair: quality of life outcomes in the elderly. Dis Esophagus 21:737–741

    Article  PubMed  CAS  Google Scholar 

  17. Gordon-Larsen P, The NS, Adair LS (2010) Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity (Silver Spring) 18:1801–1804

    Article  Google Scholar 

  18. Trieu HT, Gonzalvo JP, Szomstein S, Rosenthal R (2007) Safety and outcomes of laparoscopic gastric bypass surgery in patients 60 years of age and older. Surg Obes Relat Dis 3:383–386

    Article  PubMed  Google Scholar 

  19. Hazzan D, Chin EH, Steinhagen E, Kini S, Gagner M, Pomp A, Herron D (2006) Laparoscopic bariatric surgery can be safe for treatment of morbid obesity in patients older than 60 years. Surg Obes Relat Dis 2:613–616

    Article  PubMed  Google Scholar 

  20. Perez AR, Moncure AC, Rattner DW (2001) Obesity adversely affects the outcome of antireflux operations. Surg Endosc 15:986–989

    Article  PubMed  CAS  Google Scholar 

  21. Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD (2007) Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 21:1978–1984

    Article  PubMed  Google Scholar 

  22. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  PubMed  CAS  Google Scholar 

  23. Sise A, Friedenberg FK (2008) A comprehensive review of gastroesophageal reflux disease and obesity. Obes Rev 9:194–203

    Article  PubMed  CAS  Google Scholar 

  24. Varela JE, Hinojosa MW, Nguyen NT (2009) Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis 5:139–143

    Article  PubMed  Google Scholar 

  25. Cuschieri A (1998) Adverse cardiovascular changes induced by positive pressure pneumoperitoneum. Possible solutions to a problem. Surg Endosc 12:93–94

    Article  PubMed  CAS  Google Scholar 

  26. Hunter JG, Smith CD, Branum GD, Waring JP, Trus TL, Cornwell M, Galloway K (1999) Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg 230:595–604

    Article  PubMed  CAS  Google Scholar 

  27. Terry M, Smith CD, Branum GD, Galloway K, Waring JP, Hunter JG (2001) Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Surg Endosc 15:691–699

    Article  PubMed  CAS  Google Scholar 

  28. Finks JF, Wei Y, Birkmeyer JD (2006) The rise and fall of antireflux surgery in the United States. Surg Endosc 20:1698–1701

    Article  PubMed  Google Scholar 

  29. Wang YR, Dempsey DT, Richter JE (2010) Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Dis Esophagus. doi:10.1111/j.1442-2050.2010.01123.x

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Disclosures

Drs. Lidor, Chang, Feinberg, Steele, Schweitzer, and Franco have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Anne O. Lidor, Richard L. Feinberg, Kimberley E. Steele, Michael A. Schweitzer & Marianne M. Franco

  2. Department of Surgery, University of California San Diego, San Diego, CA, 92103, USA

    David C. Chang

  3. Johns Hopkins Hospital, 600 North Wolfe Street/Blalock 610, Baltimore, MD, 21287, USA

    Anne O. Lidor

Authors
  1. Anne O. Lidor
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  2. David C. Chang
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  3. Richard L. Feinberg
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  4. Kimberley E. Steele
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  5. Michael A. Schweitzer
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  6. Marianne M. Franco
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Corresponding author

Correspondence to Anne O. Lidor.

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Lidor, A.O., Chang, D.C., Feinberg, R.L. et al. Morbidity and mortality associated with antireflux surgery with or without paraesophogeal hernia: a large ACS NSQIP analysis. Surg Endosc 25, 3101–3108 (2011). https://doi.org/10.1007/s00464-011-1676-3

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  • DOI: https://doi.org/10.1007/s00464-011-1676-3

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