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THE IMPACT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON PARAOESOPHAGEAL HERNIA REPAIR OUTCOMES
William T. Head
*, Divyaam Satija, Stefanie C. Rohde, Theresa Wang, Kyle Perry
Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
IntroductionChronic Obstructive Pulmonary Disease (COPD) poses significant morbidity and mortality for various surgical procedures, yet its impact on paraoesophageal hernia repair (PEHR) is unknown. The objective of this study was to identify clinically relevant associations between COPD and PEHR outcomes. We hypothesized COPD would be associated with increased risk of hernia recurrence.
MethodsWe conducted a single-institution retrospective cohort study of patients undergoing elective PEHR between 2011-2022. Patients were stratified into 2 groups: those with COPD and those without COPD but with American Society of Anesthesiologists (ASA) classification of 3 or 4 ("High Risk Non-COPD"). The primary outcome of interest was early recurrence (<6 months). Demographics and outcomes data were compared using chi-squared tests for categorical variables and Mann-Whitney U tests for continuous variables. A 1:1 propensity score matching was performed to match cohorts on age, BMI, and smoking status. Standardized mean differences were used to assess balance with outcomes compared as mentioned above. Kaplan-Meier curves were used to analyze time to early recurrence and overall recurrence in both cohorts. Finally, a multivariable logistic regression model involving all patients was used to analyze independent association of COPD with early recurrence, including age, BMI, ASA class, and smoking status as confounders. Statistical significance was p<0.05.
ResultsPropensity score matching was performed on 540 patients with 62 pairs of COPD and High Risk Non-COPD patients. Table 1 displays the demographics and outcomes data. COPD was not associated with increased respiratory complications but was significantly associated with discharge to higher level of care (12.9% vs 1.61%; p=0.038) and earlier hernia recurrence (160 days vs 535.5 days; p<0.01). The Kaplan-Meier curves demonstrate increased rate of early recurrence in the COPD group (Figure 2, p=0.02) but convergence of the recurrence curves at later time points. COPD was independently associated with early recurrence on multivariable logistic regression (Odds Ratio 4.4; p<0.001).
Conclusion This study provides the first in-depth evaluation of COPD as an independent risk factor for increased morbidity after elective PEHR. While COPD patients did not have increased respiratory complications or an overall increase in recurrences compared to other High Risk Non-COPD patients, they did more often require discharge to higher level of care and developed more early recurrences. This information may inform shared decision-making with respect to elective repair in this population and suggest consideration for methods to reduce early recurrence including routine mesh placement.
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