title: Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity.
abstract: 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.affiliation: Department of Surgery, University Hospital, Spitalstr. 21, 4031 Basel, Switzerland. hannesjon@gmail.com
authors.forename: Hannes J
authors.initials: HJ
authors.lastname: Larusson
authors.forename: Urs
authors.initials: U
authors.lastname: Zingg
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.forename: Karen
authors.initials: K
authors.lastname: Delport
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Daniel
authors.initials: D
authors.lastname: Oertli
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult