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Pattern of Hiatal Hernia Repair: An Analysis of the National Inpatient Sample

Zhamak Khorgami, MD1, Guido M Sclabas, MD1, Jamin G Graham, MPH2, C. Anthony Howard, MD1, Geoffrey S Chow, MD1. 1University of Oklahoma, College of Medicine, Tulsa, USA, 2Trinity Medical Sciences University

Introduction: Patients with symptomatic hiatal hernias undergo surgical repair as a primary operation or in conjunction with other gastric and esophageal operations.  The purpose of this study is to evaluate the pattern, cost, and outcomes after Hiatal Hernia Repair (HHR) in the United States.

Method: A retrospective analysis of the Nationwide Inpatient Sample (HCUP-NIS) was performed.  Patients 18 years of age and older who underwent HHR were included for analysis.  Patient demographic factors, surgical approach, concurrent operations, length of stay, mortality, and rate of HHR over the study period were evaluated. A multivariate regression analysis was performed to identify predictors of an open operation in patients undergoing HHR as the principal surgery.

Results: 46,590 patients (mean age 58.4±15.8 years) were analyzed, and 30,893 (66.3%) were female.  A laparoscopic approach was utilized in 39,734 (78.8%), with minimal change over the study period. A transthoracic approach was utilized in 486 patients (1%). HHR was the primary operation in 40,788(87.5%) patients. The most common associated principal procedures were esophagomyotomy in 2,627(45.3%), sleeve gastrectomy in 538(9.3%), and Roux-en-Y gastric bypass in 241(4.2%).  In patients with HHR as the principal procedure, a gastrostomy tube was placed in 2,200(5.4%) and partial gastrectomy performed in 177(0.4%) patients. The median (Interquartile range, IQR) length of stay was 2(2) days in laparoscopic cases, and 5(5) days in open cases (p<0.001). The median (IQR) total charge was $30,700(30,100) for laparoscopic repair, and $40,500(45,500) for open repair (p<0.001).  Post-operative mortality was 0.5% (167) in laparoscopic cases, and 1.3% (129) in open cases (p<0.001). Age, gender, and race were similar in open and laparoscopic groups. Patients emergently admitted to a hospital had higher rates of open HHR than patients undergoing elective repair (26.4% vs 18.8%, p<0.001). On multivariate analysis, independent patient factors predicting open HHR included alcohol abuse, chronic kidney disease, coagulopathy, fluid and electrolyte abnormality, paralysis, and weight loss.

Conclusion:  The majority of HHR are performed with a laparoscopic approach, although open repair is performed in more than one-fifth of patients nationally. Length of stay, mortality, and total charges are lower in patients undergoing laparoscopic repair.  Additional education during residency and fellowship programs, development of foregut specific service lines, along with orienting trainees and surgeons about referral to specialized centers may improve patient outcomes and decrease healthcare expenditure related to hiatal hernias.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 91997

Program Number: P443

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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