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Defining risk factors for mortality after emergent hiatal hernia repair in the era of minimally invasive surgery

  • Micaela L. Collins
    Correspondence
    Corresponding author. Department of Surgery, Thomas Jefferson University Hospital 1015 Walnut StreetCurtis Building Suite 620 Philadelphia, PA, 19107, USA.
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Esophageal and Thoracic Surgery, 211 South 9th St, Suite 300, Philadelphia, PA, 19107, USA
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  • Shale J. Mack
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Esophageal and Thoracic Surgery, 211 South 9th St, Suite 300, Philadelphia, PA, 19107, USA
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  • Brian M. Till
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Esophageal and Thoracic Surgery, 211 South 9th St, Suite 300, Philadelphia, PA, 19107, USA
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  • Gregory L. Whitehorn
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Esophageal and Thoracic Surgery, 211 South 9th St, Suite 300, Philadelphia, PA, 19107, USA
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  • Christina Tofani
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Division of Gastroenterology, 132 S 10th St #480, Philadelphia, PA, 19107, USA
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  • Karen Chojnacki
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Minimally Invasive General Surgery, 1015 Walnut St, Curtis Building Suite 620, Philadelphia, PA, 19107, USA
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  • Tyler Grenda
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Esophageal and Thoracic Surgery, 211 South 9th St, Suite 300, Philadelphia, PA, 19107, USA
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  • Nathaniel R. Evans III
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Esophageal and Thoracic Surgery, 211 South 9th St, Suite 300, Philadelphia, PA, 19107, USA
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  • Olugbenga T. Okusanya
    Affiliations
    Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, 19107, USA

    Thomas Jefferson University Hospital, Department of Surgery, Division of Esophageal and Thoracic Surgery, 211 South 9th St, Suite 300, Philadelphia, PA, 19107, USA
    Search for articles by this author
Published:January 10, 2023DOI:https://doi.org/10.1016/j.amjsurg.2023.01.012

      Highlights

      • Emergent hiatal hernia repair is historically a morbid procedure.
      • Mortality rates were low across all datasets, but higher than for elective repair.
      • Complication rates and number of comorbidities were higher for those who died.
      • Most individuals who had emergent surgery received a minimally invasive repair.
      • Open surgery is independently associated with mortality after hiatal hernia repair.

      Abstract

      Background

      Risk factors for mortality following emergent hiatal hernia (HH) repair in the era of minimally invasive surgery remain poorly defined.

      Methods

      Data was obtained from the National Inpatient Sample (NIS), National Readmissions Database, and National Emergency Department Sample for patients undergoing HH repair between 2010 and 2018. Univariate and multivariate logistic regression analyses reported with odds ratio (OR) and 95% confidence intervals (CI) were performed to identify factors associated mortality.

      Results

      Via the NIS, mortality rate was 2.2% (147 patients). Via the NEDS, the mortality rate was 3.6% (303 patients). On multivariate analysis, predictors of mortality included age (OR 1.05, CI: 1.04,1.07), male sex (OR 1.49, CI: 1.06,2.11), frailty (OR 2.49, CI: 1.65,3.75), open repair (OR 3.59, CI: 2.50,5.17), and congestive heart failure (OR 2.71, CI: 1.81,4.06).

      Conclusions

      There are multiple risk factors for mortality after hiatal hernia repair. There is merit to a laparoscopic approach even in emergent settings.

      Graphical abstract

      Keywords

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