William Sherrill, MD, Brent D Matthews, MD, Caroline E Reinke, MD, MSHP. Carolinas Medical Center
Background: Utilization of minimal invasive surgery (MIS) is on the rise, and laparoscopic paraesophageal hernia (lapPEH) repairs are an increasingly common procedure. Most lapPEH repairs are performed electively, but a subset are performed during an unplanned admission. We aimed to investigate the outcomes of patients who underwent non-elective lapPEH repair compared to elective lapPEH repair. We hypothesized that patients undergoing non-elective lapPEH repair would have similar 30-day outcomes to elective patients.
Methods: This retrospective study utilized 2012-2016 NSQIP PUFs. We identified patients by CPT codes (43281, 43282). Case status was classified as elective, emergency, or urgent (non-elective, non-emergency). We compared preoperative patient characteristics, operative characteristics, and 30-day postoperative complication rates by case status. Logistic regression was used to examine the impact of case status on death or serious morbidity (DSM) and 30-day mortality.
Results: We identified 16,647 lapPEH repairs. 91% were performed electively, 7% urgent and 2% emergencies. Elective patients were younger, had a higher BMI, were more likely to be functionally independent, and were more likely to have dyspnea with moderate exertion (p<0.01). Non-elective cases had higher rates of preoperative sepsis (p<0.01). Mortality rates were higher in the non-elective cases (0.5% elective, 3% urgent, 2% emergency, p<0.01). Undergoing non-elective lapPEH repair is associated with increased odds of DSM, even after controlling for patient characteristics (Table 1). While both urgent and emergency cases were associated with an increased risk of death in univariate analysis, this association was no longer significant in emergent cases after adjustment.
Conclusions: For lapPEH repairs, patient characteristics are significantly different in the non-elective cases and mortality is higher in the urgent and emergent population. When the skill set is available, utilization of MIS techniques in the non-elective lapPEH repairs almost certainly benefits the patient, but is not enough to create outcomes equivalent to those seen in the elective procedures.
| DSM | OR | CI | p-value |
| Elective | Ref | Ref | Ref |
| Urgent | 2.11 | 1.7-2.6 | <0.01 |
| Emergency | 2.49 | 1.8-3.5 | <0.01 |
| Mortality | OR | CI | p-value |
| Elective | Ref | Ref | Ref |
| Urgent | 2.18 | 1.3-3.7 | <0.01 |
| Emergency | 0.75 | 0.23-2.48 | <0.01 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95062
Program Number: P517
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster