Inpatient mortality analysis of paraesophageal hernia repair in octogenarians.
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.
Poulose
Benjamin K
BK
Department of Surgery, University Hospitals Case Medical Center, Lakeside 7010, Mailstop 5047, 11100 Euclid Avenue, Cleveland, OH 44106, USA. benjamin.poulose@Vanderbilt.Edu
Gosen
Christine
C
Marks
Jeffrey M
JM
Khaitan
Leena
L
Rosen
Michael J
MJ
Onders
Raymond P
RP
Trunzo
Joseph A
JA
Ponsky
Jeffrey L
JL
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