Stephanie M Sims, MD, Kathleen M Coakley, DO, Tanushree Prasad, MA, Amy E Lincourt, PhD, MBA, Vedra A Augenstein, MD, FACS, B. Todd Heniford, MD, Paul D Colavita, MD. Carolinas HealthCare System
Introduction: As life expectancy of Americans increases, there has been an increased incidence of elderly patients presenting with symptomatic and asymptomatic paraesophageal hernias. The aim of this study is to evaluate outcomes following paraesophageal hernia repair in patients age 80 and older and compare to younger patients.
Methods and Procedures: The Nationwide Inpatient Sample was reviewed for all patients from 2008-2013 with ICD-9 diagnosis and procedure codes associated with paraesophageal hernia repair. Patient demographics, length of stay (LOS), patient disposition at discharge, and in-hospital mortality rates were evaluated in octogenarians and patients younger than 80.
Results: A total of 38,053 adult patients in the United States who had undergone paraesophageal hernia repair were reviewed with 2,601 (6.8%) age 80 or older. 33,378 (87.7%) of the repairs utilized a laparoscopic (N=32,930) or thoracoscopic (N=448) technique and 4,675 (12.3%) underwent a laparotomy (N=3980) or thoracotomy (N=695). Overall 18.6% of the repairs were urgent or emergent, and this was more common in octogenarians, where 53.4% of repairs were non-elective. Median LOS was 2 days (IQR 1-3) in patients under 80 years old, and 7 days (IQR 3-12) in the older group. The overall in-hospital mortality rate was 0.69%; mortality was significantly higher in octogenarian patients (5.04% vs. 0.38% p<0.0001). There was a significantly higher mortality rate in octogenarian open repairs compared with minimally invasive (9.7% vs. 2.6% p<0.0001). In the older patient population, 38.6% were discharged to a short term hospital, skilled nursing, or other type of facility, but only 3.0% were discharged to a care facility in the younger patient group. Within octogenarians, significant differences were observed between the non-elective and elective repairs in mortality rate (8.0% vs. 1.6%, p<0.0001), LOS (10 days (IQR 7-16) vs. 3 days (IQR 2-6) p<0.0001), and rate of disposition to another health care facility (54.0% vs. 20.9% p<0.0001).
Conclusions: Paraesophageal hernia repair after the age of 80 is associated with significant risk of mortality, increased length of stay, and non-home disposition, especially when surgery is urgent or emergent. The risks of both operative and nonoperative management should be part of the discussion with elderly patients with paraesophageal hernias. Elective laparoscopic repair appears to offer the best outcomes for octogenarian patients who undergo operative management of their paraesophageal hernias.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79352
Program Number: P395
Presentation Session: Poster (Non CME)
Presentation Type: Poster