OUTCOMES OF MINIMALLY INVASIVE PARAESOPHAGEAL HERNIA REPAIR IN PATIENTS WITH HISTORY OF COPD: A 5-YEAR NSQIP REVIEW
Nicholas Druar*1,2, Santosh Swaminathan2, Mitchell Cahan3,1
1University of Massachusetts Medical School, Worcester, MA; 2St. Mary's Hospital, Waterbury, CT; 3Mount Auburn Hospital, Cambridge, MA
Minimal invasive repair of paraoesophageal hernias is the standard practice. However, patients with chronic obstructive pulmonary disease (COPD) represent a group with the potential for significant poor outcomes given their already compromised respiratory status. Here we examine the outcomes of patients undergoing minimally invasive paraoesophageal hernia repair with and without a history of COPD to determine the safety of the procedure. We also further examine patients with a reported history of dyspnea as well COPD.
Patients who underwent minimally invasive paraoesophageal hernia repair were identified from the ACS-NSQIP database (2015-2019) using appropriate CPT codes. Emergency cases were excluded. Patients were excluded if data for primary variables were not available. Chi square and student's t-test were used to compare surgical characteristics and outcomes including major complications, length of procedure and readmission. Factors with p < 0.05 were included in the multivariate logistic regression for each outcome. A two-sided p value <0.05 was considered significant.
Of the 23682 procedures identified, 1223 (5.2%) procedures were performed in the patients with a history of COPD. On univariate analysis factors such as mortality, operative time, hospital length of stay, days from operation to death, days from operation to discharge, pneumonia, reintubation, readmission, combined cardiac outcomes and combined respiratory outcomes were found to be statistically different (p<0.05). When controlling for significant preoperative risk factors and surgical characteristics, the risk of pneumonia (OR 2.07), reintubation (OR 1.98), myocardial infarction (OR 2.13) and readmission (OR 1.34) remained significant (p<0.05) on multiple regression model. On subgroup analysis of patients with dyspnea and a history of COPD, mortality (OR 2.81) is significantly different (p<0.05).
When examining the outcomes of patients with COPD compared to those without a history of COPD patients are at a higher risk of multiple poor outcomes. However, there was no difference in overall mortality found unless a subgroup of patients with dyspnea is considered. This analysis highlights the importance of preoperative optimization prior to surgery to support high quality surgical care.
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