Lindsey N Clark1, Melissa C Helm1, Rana Higgins1, Kathleen Lak1, Andrew Kastenmeier1, Tammy Kindel1, Matthew Goldblatt1, Jon C Gould2. 1. Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA. 2. Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA. jgould@mcw.edu.
Abstract
BACKGROUND: Patients with a paraesophageal hernia may experience gastroesophageal reflux symptoms and/or obstructive symptoms such as dysphagia. Some patients with large and complex paraesophageal hernias unintentionally lose a significant amount of weight secondary to difficulty eating. A subset of patients will develop Cameron's erosions in the hernia, which contribute to anemia. Given the heterogeneous nature of patients who ultimately undergo paraesophageal hernia repair, we sought to determine if patients with anemia or malnutrition suffered from increased morbidity or mortality. METHODS: The American College of Surgeons National Surgical Quality Improvement Program datasets from 2011 to 2015 were queried to identify patients undergoing paraesophageal hernia repair. Malnutrition was defined as preoperative albumin < 3.5 g/dL. Preoperative anemia was defined as hematocrit less than 36% for females and 39% for males. Thirty-day postoperative outcomes were assessed. RESULTS: A total of 15,105 patients underwent paraesophageal hernia repair in the study interval. Of these patients, 7943 (52.6%) had a recorded preoperative albumin and 13.9% of these patients were malnourished. There were 13,139 (87%) patients with a documented preoperative hematocrit and 23.1% met criteria for anemia. Both anemia and malnutrition were associated with higher rates of complications, readmissions, reoperations, and mortality. This was confirmed on logistic regression. The average postoperative length of stay was longer in the malnourished (6.1 vs. 3.1 days when not malnourished, p < 0.0001) and anemic (4.1 vs. 2.8 days without anemia, p < 0.0001). CONCLUSION: Malnutrition and anemia are associated with increased morbidity and mortality in patients undergoing paraesophageal hernia repair, as well as a longer length of stay. This information can be used for risk assessment and perhaps preoperative optimization of these risk factors when clinically appropriate.
BACKGROUND:Patients with a paraesophageal hernia may experience gastroesophageal reflux symptoms and/or obstructive symptoms such as dysphagia. Some patients with large and complex paraesophageal hernias unintentionally lose a significant amount of weight secondary to difficulty eating. A subset of patients will develop Cameron's erosions in the hernia, which contribute to anemia. Given the heterogeneous nature of patients who ultimately undergo paraesophageal hernia repair, we sought to determine if patients with anemia or malnutrition suffered from increased morbidity or mortality. METHODS: The American College of Surgeons National Surgical Quality Improvement Program datasets from 2011 to 2015 were queried to identify patients undergoing paraesophageal hernia repair. Malnutrition was defined as preoperative albumin < 3.5 g/dL. Preoperative anemia was defined as hematocrit less than 36% for females and 39% for males. Thirty-day postoperative outcomes were assessed. RESULTS: A total of 15,105 patients underwent paraesophageal hernia repair in the study interval. Of these patients, 7943 (52.6%) had a recorded preoperative albumin and 13.9% of these patients were malnourished. There were 13,139 (87%) patients with a documented preoperative hematocrit and 23.1% met criteria for anemia. Both anemia and malnutrition were associated with higher rates of complications, readmissions, reoperations, and mortality. This was confirmed on logistic regression. The average postoperative length of stay was longer in the malnourished (6.1 vs. 3.1 days when not malnourished, p < 0.0001) and anemic (4.1 vs. 2.8 days without anemia, p < 0.0001). CONCLUSION:Malnutrition and anemia are associated with increased morbidity and mortality in patients undergoing paraesophageal hernia repair, as well as a longer length of stay. This information can be used for risk assessment and perhaps preoperative optimization of these risk factors when clinically appropriate.
Authors: Justin R Gregg; Michael S Cookson; Sharon Phillips; Shady Salem; Sam S Chang; Peter E Clark; Rodney Davis; C J Stimson; Monty Aghazadeh; Joseph A Smith; Daniel A Barocas Journal: J Urol Date: 2010-11-12 Impact factor: 7.450
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: James D Luketich; Katie S Nason; Neil A Christie; Arjun Pennathur; Blair A Jobe; Rodney J Landreneau; Matthew J Schuchert Journal: J Thorac Cardiovasc Surg Date: 2009-12-11 Impact factor: 5.209
Authors: Marco La Torre; Vincenzo Ziparo; Giuseppe Nigri; Marco Cavallini; Genoveffa Balducci; Giovanni Ramacciato Journal: J Surg Oncol Date: 2012-12-27 Impact factor: 3.454