William C Sherrill, MD, Brent D Matthews, MD, Caroline E Reinke, MD, MSHP. Carolina Medical Center
Background: Over the past decade with the continuing increase of minimally invasive surgery (MIS) techniques, complex MIS procedures such as laparoscopic paraesophageal hernia (PEH) repair are on the rise. The majority of these hernia repairs are being performed in the elective setting, however a subset of these are still being performed in a non-elective setting. We aimed to determine the utilization of laparoscopic surgery in non-elective procedures and to compare outcomes with laparoscopy versus the open abdominal and thoracic outcomes. We hypothesized that patients undergo non-elective laparoscopic paraesophageal hernias would have decreased mortality and 30-day outcomes compared to non-elective open abdominal or thoracic approaches.
Methods: The American College of Surgeons, National Surgical Quality Improvement Program (ACS NSQIP) 2011-2016 Database was queried for ICD-10 codes associated with paraesopahgeal hernia repairs (43332, 43333, 43281, 43282, 43335, 43336 and 43337). Patient undergoing no-elective procedures were identified and classified by surgical approach. We compared preoperative patient characteristics, operative characteristics, discharge destination, and 30-day postoperative complication rates by surgical approach. Logistic regression was used to examine the impact of operative approach on death or serious morbidity (DSM) and 30-day mortality.
Results: A total of 2,198 patients were found to have undergone non-elective paraesophageal hernia repair. 73% of these were done laparoscopically, 24% with an abdominal approach, and 2% were done through a thoracic-based approach. Over the 6-year study period, there was an increase in the percentage of MIS approaches from 72% to 81%, with an accompanying decrease in abdominal approaches 25% to 18%. Overall mortality was 6% in the abdominal approach, 3% in the laparoscopic approach and 7% in the thoracic approach (p<0.01). Utilization of a laparoscopic approach was found to be associated with a lower odds of mortality, decreased length of stay, and decreased odds of surgical site infections. When compared to open abdominal surgery, using multivariable regression analysis, MIS approach was found to have a statistically significant decreased odds of mortality (OR=0.43). This was also found when examining the impact of an MIS approach on surgical site infections and mortality (OR=0.31 and OR=0.27 respectively).
Conclusions: Over the 6 years studied, an increasing percentage of non-elective paraesophageal hernia repairs are being performed in a minimally invasive fashion. Using data from NSQIP we observed decreased mortality, decreased hospital length of stay and decreased surgical site infections when MIS techniques were used.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93791
Program Number: S067
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel