title: Inpatient mortality analysis of paraesophageal hernia repair in octogenarians.
abstract: BACKGROUND
  Paraesophageal hernia repair is often performed in an elderly population. Few studies have evaluated perioperative mortality in this group. We identified predictors of inpatient mortality using a nationally representative sample.
  
  
  METHODS
  Patients >/=80 years old undergoing transabdominal paraesophageal hernia repair were identified in the 2005 Nationwide Inpatient Sample. Congenital diaphragmatic defects and traumatic injuries were excluded.
  
  
  RESULTS
  One thousand five discharges (73% female) with mean age 84.7 met inclusion criteria. Mean length of stay was 10.1 days (95% confidence interval 8.9-11.3) with a mortality of 8.2%. Non-elective repair was performed in 43%. For these patients, mortality and mean length of stay (16%; 14.3 days) were increased compared to elective repair (2.5%; 7.0 days, p < 0.05). Non-elective repair was the sole predictor of inpatient mortality in adjusted analyses (odds ratio 7.1, 95% confidence interval 1.9-26.3, p < 0.05).
  
  
  CONCLUSIONS
  Non-elective repair was associated with a six to sevenfold increase in mortality and longer length of stay. Earlier elective repair of paraesophageal hernia may reduce mortality.
authors.affiliation: Department of Surgery, University Hospitals Case Medical Center, Lakeside 7010, Mailstop 5047, 11100 Euclid Avenue, Cleveland, OH 44106, USA. benjamin.poulose@Vanderbilt.Edu
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
authors.forename: Christine
authors.initials: C
authors.lastname: Gosen
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
authors.forename: Leena
authors.initials: L
authors.lastname: Khaitan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Onders
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Trunzo
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ponsky
mesh_terms: D000369:Aged, 80 and over; D002423:Cause of Death; D016001:Confidence Intervals; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D018662:Fundoplication / Q000379:methods / Q000401:mortality*; D015577:Geriatric Assessment; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index