THE CHALLENGE OF BENIGN INCIDENTALOMAS: IDENTIFYING AND MAPPING THE NATURAL COURSE OF HIATAL HERNIAS
Johanna Lou*1, Keshav Kooragayala1, Jennifer Williams1, Connor Crudeli2, Justin Junus1, Ami Kalola2, Georgianna Sandilos1, Margaret V. Butchy1, David Shersher1, Jennifer Burg3
1Surgery, Cooper University Health Care, Camden, NJ; 2Rowan University Cooper Medical School, Camden, NJ; 3MaineHealth, Portland, ME
Objective
Computed tomography (CT) imaging routinely detects incidental findings, including hiatal hernias. We utilized a natural language processing algorithm to identify incidental hiatal hernias, characterize their natural progression, and evaluate clinical follow-up.
Methods
Imaging of adult trauma patients from 2010-2020 who underwent CT chest and/or abdomen/pelvis was evaluated using an open-source natural language processor query for hiatal hernias. Patients who underwent subsequent imaging, endoscopy, fluoroscopy or operation were retrospectively reviewed.
Results
1,087 of 10,299 patients (10.6%) had incidental hiatal hernias: 812 small (74.7%) and 275 moderate/large (25.3%). 224 patients (20.7%) had subsequent imaging or endoscopic evaluation, with a mean follow up of 2.78 ± 2.79 years. Patients with moderate/large hernias were older (small vs moderate/large: 66.3±19.4 vs 79.6±12.6 years,p<0.001) and predominantly female (small vs moderate/large: 403[49.6%] vs 199[72.4%],p<0.001). Hernia size was not associated with hernia growth (small vs moderate/large: 13[7.6%] vs 8[15.1%],p=0.102) or symptomology (small vs moderate/large 55.6% vs 67.9%,p=0.110) (Table.1). Though patients with moderate/large hernia were more likely to have an intervention/referral (small vs moderate/large 6[3.5%] vs 7[13.2%], p=0.008), more than 80% of symptomatic patients (n=28) with moderate/large hernias had no follow-up. No patients underwent elective or emergent hernia repair. Three patients had surgical referral; however, only one was seen by a surgeon. One patient death was associated with a large hiatal hernia.
Conclusions
We demonstrate a novel utilization of an NLP to identify patients with incidental hiatal hernia in a large population, and found a 10.6% incidence with only 1.2% of these receiving a referral for follow-up. While most incidental hiatal hernias are small, moderate/large hernias have very high risk of loss-to-follow up and need referral pipelines to improve patient outcomes.
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