title: A population-based analysis of emergent versus elective paraesophageal hernia repair using the Nationwide Inpatient Sample.
abstract: BACKGROUND
  As the life expectancy in the United States continues to increase, more elderly, sometimes frail patients present with sub-acute surgical conditions such as a symptomatic paraesophageal hernia (PEH). While the outcomes of PEH repair have improved largely due to the proliferation of laparoscopic surgery, there is still a defined rate of morbidity and mortality. We sought to characterize the outcomes of both elective and emergent PEH repair using a large population-based data set.
  
  
  METHODS
  The Nationwide Inpatient Sample was queried for primary ICD-9 codes associated with PEH repair (years 2006-2008). Outcomes were in-hospital mortality and the occurrence of a pre-identified complication. Multivariate analysis was performed to determine the risk factors for complications and mortality following both elective and emergent PEH repair.
  
  
  RESULTS
  A total of 8,462 records in the data, representing 41,723 patients in the US undergoing PEH repair in the study interval, were identified. Of these procedures, 74.2% was elective and 42.4% was laparoscopic. The overall complication and mortality rates were 20.8 and 1.1%, respectively. Emergent repair was associated with a higher rate of morbidity (33.4 vs. 16.5%, p < 0.001) and mortality (3.2 vs. 0.37%, p < 0.001) than elective repair. Emergent repair patients were more likely to be male, were older, and more likely to be minority. Logistic modeling revealed that younger age, elective case status, and a laparoscopic approach were independently associated with a lower probability of complications and mortality.
  
  
  CONCLUSIONS
  Patients undergoing emergent PEH repair in the United States tend to be older, more likely a racial minority, and less likely to undergo laparoscopic repair. Elective repair, younger age, and a laparoscopic approach are associated with improved outcomes. Considering all of the above, we recommend that patients consider elective repair with a surgeon experienced in the laparoscopic approach, especially when symptoms related to the hernia are present.
authors.affiliation: Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
authors.forename: Hassanain
authors.initials: H
authors.lastname: Jassim
authors.forename: Johnathan T
authors.initials: JT
authors.lastname: Seligman
authors.forename: Matthew
authors.initials: M
authors.lastname: Frelich
authors.forename: Matthew
authors.initials: M
authors.lastname: Goldblatt
authors.forename: Andrew
authors.initials: A
authors.lastname: Kastenmeier
authors.forename: James
authors.initials: J
authors.lastname: Wallace
authors.forename: Heather S
authors.initials: HS
authors.lastname: Zhao
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.forename: Jon C
authors.initials: JC
authors.lastname: Gould
mesh_terms: D000368:Aged; D017558:Elective Surgical Procedures / Q000379:methods*; D004630:Emergencies; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology