BACKGROUND: Patients undergoing laparoscopic paraesophageal hernia (PEH) repair risk substantial morbidity. The aim of the present study was to analyze predictive factors for postoperative morbidity and mortality. METHODS: A total of 354 laparoscopic PEH repairs were analyzed from the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS). Age (<70 and > or =70 years) and risk (low: American Society of Anesthesiologists (ASA) scores 1 + 2; high ASA scores 3 + 4) groups were defined and multivariate logistic regression was conducted. RESULTS: In patients > or =70 years of age postoperative morbidity (24.4% versus 10.1%; p = 0.001) and mortality (2.4% versus 0%; p = 0.045) were significantly higher than in patients <70 years of age. In patients with gastropexy, this significant age difference was again present (38.8% versus 10.5%; p = 0.001) whereas in patients with fundoplication no difference between age groups occurred (11.9% versus 10.1%; p = 0.65). Mortality did not differ. High-risk patients had a significantly higher morbidity (26.0% versus 11.2%; p = 0.001) but not mortality (2.1% versus 0.4%; p = 0.18). The multivariate logistic regression identified the following variables as influencing postoperative morbidity: Age > or =70 years (Odds Ratio [OR] 1.99 [95% CI 1.06 to 3.74], p = 0.033); ASA 3 + 4 (OR 2.29 [95% Confidence Interval (CI) 1.22 to 4.3]; p = 0.010); type of operation (gastropexy) (OR 2.36 [95% CI 1.27 to 4.37]; p = 0.006). CONCLUSIONS: In patients undergoing laparoscopic paraesophageal hernia repair age, ASA score, and type of operation significantly influence postoperative morbidity and mortality. Morbidity is substantial among elderly patients and those with co-morbidity, questioning the paradigm for surgery in all patients. The indication for surgery must be carefully balanced against the individual patient's co-morbidities, age, and symptoms, and the potentially life threatening complications.
BACKGROUND:Patients undergoing laparoscopic paraesophageal hernia (PEH) repair risk substantial morbidity. The aim of the present study was to analyze predictive factors for postoperative morbidity and mortality. METHODS: A total of 354 laparoscopic PEH repairs were analyzed from the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS). Age (<70 and > or =70 years) and risk (low: American Society of Anesthesiologists (ASA) scores 1 + 2; high ASA scores 3 + 4) groups were defined and multivariate logistic regression was conducted. RESULTS: In patients > or =70 years of age postoperative morbidity (24.4% versus 10.1%; p = 0.001) and mortality (2.4% versus 0%; p = 0.045) were significantly higher than in patients <70 years of age. In patients with gastropexy, this significant age difference was again present (38.8% versus 10.5%; p = 0.001) whereas in patients with fundoplication no difference between age groups occurred (11.9% versus 10.1%; p = 0.65). Mortality did not differ. High-risk patients had a significantly higher morbidity (26.0% versus 11.2%; p = 0.001) but not mortality (2.1% versus 0.4%; p = 0.18). The multivariate logistic regression identified the following variables as influencing postoperative morbidity: Age > or =70 years (Odds Ratio [OR] 1.99 [95% CI 1.06 to 3.74], p = 0.033); ASA 3 + 4 (OR 2.29 [95% Confidence Interval (CI) 1.22 to 4.3]; p = 0.010); type of operation (gastropexy) (OR 2.36 [95% CI 1.27 to 4.37]; p = 0.006). CONCLUSIONS: In patients undergoing laparoscopic paraesophageal hernia repair age, ASA score, and type of operation significantly influence postoperative morbidity and mortality. Morbidity is substantial among elderly patients and those with co-morbidity, questioning the paradigm for surgery in all patients. The indication for surgery must be carefully balanced against the individual patient's co-morbidities, age, and symptoms, and the potentially life threatening complications.
Authors: Noopur Gangopadhyay; Juan M Perrone; Nathaniel J Soper; Brent D Matthews; J Christopher Eagon; Mary E Klingensmith; Margaret M Frisella; L Michael Brunt Journal: Surgery Date: 2006-09-06 Impact factor: 3.982
Authors: J J Andujar; P K Papasavas; T Birdas; J Robke; Y Raftopoulos; D J Gagné; P F Caushaj; R J Landreneau; R J Keenan Journal: Surg Endosc Date: 2004-02-02 Impact factor: 4.584
Authors: Anne O Lidor; David C Chang; Richard L Feinberg; Kimberley E Steele; Michael A Schweitzer; Marianne M Franco Journal: Surg Endosc Date: 2011-04-22 Impact factor: 4.584
Authors: Chieh Yang Koo; Joseph A Hyder; Jonathan P Wanderer; Matthias Eikermann; Satya Krishna Ramachandran Journal: World J Surg Date: 2015-01 Impact factor: 3.352
Authors: David M Parker; Amrit A Rambhajan; Ryan D Horsley; Kathleen Johanson; Jon D Gabrielsen; Anthony T Petrick Journal: Surg Endosc Date: 2016-07-15 Impact factor: 4.584