Introduction: Paraesophageal hernia (PEH) repair is often performed in an elderly population. Few studies have evaluated perioperative mortality in this high risk group. We examined outcomes of patients who underwent PEH repair and identified predictors of inpatient mortality using a national dataset.
Methods: Patients 80 years of age or older undergoing PEH repair from an abdominal approach were identified in the 2005 Nationwide Inpatient Sample (NIS). A coding algorithm was developed to include patients with type II, III, and IV hiatal hernias while excluding those with congenital diaphragmatic defects or traumatic injuries. Statistical methodology appropriate for NIS analysis was used accounting for its weighted and stratified database structure.
Results: 1005 patients with mean age of 84.7 years met inclusion criteria for analysis including 738 women (73%) and 267 men (27%). Overall inpatient mortality was 8.2% with mean length of stay 10.1 days. Emergent or urgent repair was performed in 43% of patients. In this group, length of stay (14.3 days) and mortality (16%) were increased compared to patients undergoing elective repair (7.0 days and 2.5% mortality; p<0.05). A 7.1 increase in odds of death was observed for non-elective patients in univariate analysis (95% CI of 2.1-24.9, p<0.05). Chronically symptomatic patients admitted electively were not associated with increased odds for death. When controlling for gender, hospital characteristics and comorbidities, emergent or urgent repair remained the sole predictor of inpatient mortality (odds ratio 6.2, 95% CI 1.8-21.3, p<0.05).
Conclusion: This study defines demographics, length of stay, and inpatient mortality risk in elderly patients undergoing PEH. Emergent or urgent repair was associated with an increased inpatient length of stay and mortality, including a 6 to 7 fold increase in the odds of death. However, chronically symptomatic patients who underwent elective repair were not at increased odds for inpatient death. Based on these data, earlier elective repair of PEH may reduce mortality.