|
|
Back to 2017 Posters
IS ELECTIVE SURGICAL REPAIR OF PARAESOPHAGEAL HIATAL HERNIA WARRANTED IN ELDERLY POPULATION: A COMPARATIVE ANALYSIS OF 38,817 PATIENTS FROM NATIONAL INPATIENT SAMPLE DATABASE (1998-2010)
Sachin Patil*, Janak Parikh, Michael J. Jacobs
HPB Surgery, Ascension Providence Hospital, Troy, MI
Introduction: Surgical management of paraesophageal hiatal hernia (PHH) is reserved for patients with gastric outlet obstruction, strangulation of stomach, sever GERD or anemia. Asymptomatic or patients with mild symptoms are denied surgery, especially elderly population >65 years of age. With the increasing longevity the prevalence of PHH and the need for surgical repair in the elderly population is increasing. This study looked at the outcomes of hiatal hernia repair in elderly population.
Methods: National Inpatient Database (NIS 1998-2010) was used to identify patient who had received PHH repair as a primary procedure (ICD-9-PR code 53.70, 53.72, 53.75, 53.80, 53.84, 53.71 and 52.83). Demographic, Clinical, Hospital and Outcomes data was abstracted and compared amongst six different age groups using standard statistical methodology and p <0.05 was set as statistical significance. Discharge Weights were applied to the study population to get National estimates. Multivariate analysis was conducted to indentify independent factors affecting mortality following PHH repair.
Results: 38,817 patients received PHH repair between 1998 and 2010, of whom 41.3% (N=16,040) were elderly. Overall more females (1.7:1) compared to males underwent PHH repair and the gap increased further with increasing age, p <0.001. On the contrary to the Caucasians, with the increasing age less number of African American and Hispanic patients underwent PPH repair compared to their younger counterpart (age <65%), p<0.001. The Charlson score was higher in the elderly, p <0.001. Overall 61.7% (N=21,350) received elective PPH repair, which was lowest in patients >86 years (28.6%; N=473). Majority of the younger population were discharged to Home after PPH repair whereas higher number of elderly population were discharged to nursing home, p <0.001. Overall mortality was 2.1%, whereas it highest among patients >86 years (10.2%). The choice of surgical procedure varied widely among different age groups, notably one third of the elderly population received open thoracic repair. The number of PPH repairs performed in Teaching and Urban hospitals significantly decreased with increasing age, p <0.001. Both the medical and surgical complications increased in elderly population with increasing age, p< 0.01. On multivariate analysis Age > 65 years, high Charlson score, Non-teaching hospital, urban hospital, respiratory complications, DVT, type of surgical repair, and post-op intra-abdominal infection independently increased mortality in patients undergoing PPH repair
Conclusion: More than 40% of PHH repair are done in elderly population >65 years of age. Increasing age and worsening of associated co-morbidities increase morbidity and mortality in elderly patients after PHH repair, thus affecting technical success. Consideration should be given for earlier than later repair of PHH in elderly.
Table 1 Demographic and Clinical data on 38,898 patients undergoing Paraesophageal Hiatal Hernia Repair, separated according to six different age groups, National Inpatient Sample Database (1998-2010)
| | Overall | <65 years | 66-70 Years | 71-75 Years | 76-80 Years | 81-85 Years | >86 Years | | N (%) | 38,898 | 22,848 (58.7) | 4,174 (10.7) | 3,693 (9.5) | 3,749 (9.6) | 2,616 (6.7) | 1,817 (4.7) | | Male: Female | 1: 1.7 | 1: 1.4 | 1: 2.3 | 1: 2.5 | 1: 2.7 | 1: 2.4 | 1: 3.0 | | Charlson Score >3, N (%) | 2,661 (6.8) | 288 (1.3) | 131 (3.1) | 591 (16.0) | 659 (17.6) | 539 (20.6) | 453 (24.9) | | Elective Admission, N (%) | 2,1350 (61.7) | 12,695 (63.2) | 2,734 (72.7) | 2,193 (65.0) | 2,089( 61.2) | 1,166 (50.1) | 473 (28.6) | | Type of Surgery, N (%) | | | | | | | | | Open Abdominal Repair | 8,542 (22.0) | 4,462 (19.5) | 944 (22.6) | 881 (23.9) | 859 (22.9) | 753 (28.8) | 643 (35.4) | | Open Thoracic Repair | 15,626 (40.2) | 10,587 (46.3) | 1,355 (32.5) | 1,240 (33.6) | 1,280 (34.1) | 787 (30.1) | 377 (20.7) | | Laparoscopic Abdominal Repair | 14,606 (37.6) | 7,677 (33.6) | 1,875 44.9) | 1,572 (42.6) | 1,610 (42.9) | 1,075 (41.1) | 797 (43.9) | | Thoracoscopic Repair | 122 (0.3) | 122 (0.5) | 0 | 0 | 0 | 0 | 0 | | Discharge to Home, N (%) | 29,478 (75.8) | 19,945 (87.4) | 3,323 (79.6) | 2,511 (68.0 | 2,142 (57.2) | 1,139 (43.5) | 418 (23.0) | | Mortality, N (%) | 822 (2.1) | 281 (1.2) | 48 (1.1) | 101 (2.7) | 118 (3.2) | 89 (3.4) | 185 (10.2) | | Teaching Hospital, N (%) | 24,175 (63.3) | 15,121 (67.5) | 2,492 (60.8) | 2,192 (60.4) | 2,098 (56.6) | 1,382 (53.8) | 890 (49.7) | | Urban Hospital, N (%) | 35,458 (92.9) | 21,031 (93.9) | 3,783 (92.3) | 3,342 (92.1) | 3,342 (90.2) | 2,351 (91.5) | 1,609 (89.8) | | Complications, N (%) | | | | | | | | | Medical Complications | | | | | | | | | Respiratory | 4,228 (10.9) | 2,069 (9.1) | 534 (12.8) | 468 (12.7) | 523 (14.0) | 333 (12.7) | 301 (16.6) | | Cardiac | 984 (2.5) | 298 (1.3) | 148 (3.5) | 133 (3.6) | 141 (3.8) | 155 (5.9) | 109 (6.0) | | Post-op Stroke | 73 (0.2) | 21 (0.1) | * (0.2) | * (0.1) | 33 (0.9) | 0 | *(0.2) | | Urinary | 270 (0.7) | 124 (0.5) | 20 (0.5) | 13 (0.4) | 47 (1.3) | 56 (2.1) | *(0.6) | | Sepsis | 368 (0.9) | 157 (0.7) | 47 (1.1) | 29 (0.8) | 55 (1.5) | 41 (1.6) | 39 (2.1) | | Renal Failure | 270 (0.7) | 124 (0.5) | 20(0.5) | 13 (0.4) | 47 (1.3) | 56 (2.1) | *(0.6) | | Surgical Complications | | | | | | | | | Gastrointestinal | 2,466 (6.3) | 1,683 (7.4) | 193 (4.6) | 191 (5.2) | 197 (5.3) | 101 (3.9) | 101 (5.6) | | Post-op Hemorrhage | 1,618 (4.2) | 803 (3.5) | 136 (3.3) | 214 (5.8) | 237 (6.3) | 129 (4.9) | 99 (5.4) | | DVT | 173 (0.4) | 79 (0.3) | * (0.1) | 20 (0.5) | 22 (0.6) | 21 (0.8) | 26 (1.4) | | Intra-abdominal Infection | 660 (1.7) | 375 (1.6) | 77 (1.8) | 45 (1.2) | 83 (2.2) | 56 (2.1) | 24 (1.3) | | Wound complications | 237 (0.6) | 153 (0.7) | 31 (0.7) | *(0.1) | 25 (0.7) | 14 (0.5) | *(0.5) | | Overall LOS, Mean(SD) | 8.9 (14.1) | 9.3 (16.8) | 6.5 (7.1) | 7.4 (7.2) | 8.5 (9.6) | 10.5 (10.4) | 12.1 (9.4) | | LOS from admission to surgery, Mean (SD) | 1.3 (4.4) | 1.3 (5.0) | 0.7 (2.8) | 1.0 (2.8) | 1.4 (3.7) | 2.2 (4.1) | 2.6 (3.6) |
Abbreviations: N; Number of patients, Post-op; post-operative, DVT; Deep vein thrombosis, LOS; length of stay, SD; Standard deviation
Back to 2017 Posters
|
