EVOLVING NATIONAL PRACTICE PATTERNS FOR MANAGEMENT OF PARAESOPHAGEAL HERNIA: A POPULATION BASED STUDY
Thai H. Pham MD, Kyle A. Perry MD, Eugene Y. Chang MD, Brian S. Diggs PhD, John G Hunter MD, Brett C Sheppard MD. Department of Surgery, Oregon Health and Science University, Portland, OR.
Introduction: Based on studies from specialized centers, laparoscopic paraesophageal hernia (PEH) repair has proven to be a safe and effective procedure. We hypothesized that during the past decade, both the total number of PEH repairs and the proportion approached laparoscopically have increased. The aim of this population based study was to examine the evolution of national practice patterns for the management of PEH.
Methods: The Nationwide Inpatient Sample (NIS) database was queried from 1996-2006 using ICD-9 diagnosis codes for PEH and gastroesophageal reflux disease. Based on procedure codes, PEH repairs were categorized as laparoscopic, transthoracic, or open abdominal. National estimates of inpatient mortality, morbidity, and patient characteristics were computed.
Results: An estimated 97,757 PEH repairs were performed during the study period. The number of PEH repairs performed annually increased from 6,957 cases in 1996 to 9,366 in 2001 and then to 10,409 cases in 2006. Overall, 76.7% were performed via laparotomy, 13.5% transthoracic and 9.8% laparoscopically. During the study period, laparoscopic repairs have decreased as outlined in the table below. Laparoscopic repair was associated with significantly improved mortality (0.93%, p=0.004) and morbidity (7.63%, p=0.0001) compared to transthoracic (1.37% and 12.8%) and laparotomy (1.32% and 9.77%).
Conclusion: As expected, this population based analysis demonstrates a steady increase in the total number of PEH repairs performed annually in the United States. Despite its lower morbidity and mortality, laparoscopic PEH repair has yet to gain national acceptance.
1996 1998 2000 2002 2004 2006
Open Abd. 71.9% 72.9% 73.7% 75.0% 77.3% 85.4%
TT 13.2% 13.4% 15.2% 14.7% 12.4% 11.0%
Lap 14.9% 13.6% 11.0% 10.3% 10.3% 3.6%
Program Number: P348