title: Morbidity and mortality associated with antireflux surgery with or without paraesophogeal hernia: a large ACS NSQIP analysis.
abstract: BACKGROUND
  Surgical repair of paraesophageal hernias (PEH) represents a considerable technical challenge in patients who are older and have multiple comorbidities. We sought to identify factors associated with increased rates of mortality and morbidity in these patients.
  
  
  METHODS
  We performed a retrospective analysis of the National Surgical Quality Improvement Program from 2005 through 2007. Patients who underwent an antireflux operation or repair of PEH and with a primary diagnosis of PEH or GERD were included. Primary outcome was 30-day mortality. Secondary outcomes included intraoperative blood transfusion (BT) and standard comorbidities. Multivariate analyses were performed, adjusting for factors of age and BMI.
  
  
  RESULTS
  A total of 3518 patients were identified, including 1290 PEH patients. Compared to GERD patients, PEH patients were significantly older and had more comorbidities. On adjusted analysis for PEH patients only, BT and age ≥70 years were significantly associated with multiple outcome variables, including pulmonary complications and venous thromboembolism (VTE), but had no association with mortality. BMI was not found to be associated with any of our outcome measures.
  
  
  CONCLUSIONS
  Despite higher rates of complications, notably pulmonary and VTE, PEH can be repaired in the elderly with mortality rates comparable to those in younger populations. BMI does not adversely impact any short-term outcome measures in patients undergoing PEH repair.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. alidor1@jhmi.edu
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Richard L
authors.initials: RL
authors.lastname: Feinberg
authors.forename: Kimberley E
authors.initials: KE
authors.lastname: Steele
authors.forename: Michael A
authors.initials: MA
authors.lastname: Schweitzer
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Franco
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003625:Data Collection; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D058996:Quality Improvement / Q000458:organization & administration / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012955:Societies, Medical / Q000458:organization & administration; D013923:Thromboembolism / Q000453:epidemiology / Q000401:mortality; D014481:United States