Matthew D Skancke, MD, Clint Schoolfield, MD, Richard Amdur, Fredrick J Brody, MD. George Washington University
Purpose: Mesh utilization and its impact on postoperative hernia recurrence following paraesophageal hernia repair remains a polarizing topic. This analysis evaluates the recent trends in laparoscopic paraesophageal hernia repairs and analyzes the impact of operative time on postoperative morbidity.
Methods: The 2013-2015 ACS-NSQIP database was queried for primary CPT code for laparoscopic paraesophageal hernia repair with and without mesh (43282/43281). Only elective cases performed by a general surgeon were included. Operative time was grouped into quartiles (80-110, 111-142, 143-185, 186-360 minutes) and statistical analysis was performed using ANOVA univariate with post-hoc testing and multivariate regression modeling controlling for age, diabetes, renal disease and weight loss. This analysis was powered to detect a greater than 2% difference in outcomes based on mesh utilization. The outcomes of interest were composite morbidity scores and readmission rates within 30 days of surgery.
Results: The database identified a cohort of 6,234 laparoscopic paraesophageal hernia repairs performed between 2013 and 2015. Average patient age was 64 years and average patient Body Mass Index was 31. Mesh was utilized in 42% of cases per year and did not change over the study period (p = 0.367) however mesh utilization was 37%, 40%, 43%, and 49% within operative time quartiles 1,2,3, and 4 respectively (p <0.001).
Postoperative morbidity and readmission rates for each operative time quartile were 2.8%, 4.1%, 5.42%, and 6.13% (p<0.001) and 4.4%, 5%, 6.2%, and 7.6% (p=0.001), respectively. Post-hoc testing indicated statistically significant differences in postoperative morbidity and readmission rates between quartiles 1 and 3/4. Multivariate regression analysis documented operative time as a risk factor for postoperative morbidities and readmission, even after controlling for covariates. Mesh utilization was only significant for a reduction in the rate of venous thromboembolic complications (OR 0.493, p = 0.027) but did not impact other morbidities or readmission rates.
Conclusion: This analysis suggests that patients with higher operative times have increased postoperative morbidity and readmission while mesh utilization does not impact postoperative outcomes, after accounting for the longer operative time of a paraesophageal hernia repair with mesh.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85172
Program Number: P467
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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