title: Improved patient outcomes in paraesophageal hernia repair using a laparoscopic approach: a study of the national surgical quality improvement program data.
abstract: A consensus on the optimal surgical approach for repair of a paraesophageal hernia has not been reached. The aim of this study was to examine the outcomes of open and laparoscopic paraesophageal hernia repairs (PHR), both with and without mesh. A review of the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2011 was conducted. Patients who underwent an open or laparoscopic PHR were included. The primary outcome was 30-day mortality. Secondary outcomes included infections, respiratory and cardiac complications, intraoperative or perioperative transfusions, sepsis, and septic shock. Statistical analyses using odds ratios were performed comparing the open and laparoscopic approaches. A total of 4470 patients were identified using NSQIP; 2834 patients had a laparoscopic repair and the remaining 1636 patients underwent an open PHR. Compared with the laparoscopic approach, the open repair group had significantly higher 30-day mortality (odds ratio, 4.75; 95% confidence interval, 2.67 to 8.47; P < 0.0001). The laparoscopic approach had a statistically significant decrease in infections, respiratory and cardiac events/complications, transfusion requirements, episodes of sepsis, and septic shock (P < 0.05). Our data suggest increased perioperative morbidity associated with an open PHR compared with laparoscopic. There was no statistically significant difference in any of the primary or secondary outcomes in patients repaired with mesh compared with those without. The overall use of mesh in paraesophageal hernia repairs has increased. The NSQIP data show significantly increased 30-day mortality in open repair compared with laparoscopic as well as a significantly higher perioperative complication rate.
authors.affiliation: Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kubasiak
authors.forename: Keith C
authors.initials: KC
authors.lastname: Hood
authors.forename: Shaun
authors.initials: S
authors.lastname: Daly
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Deziel
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Myers
authors.forename: Keith W
authors.initials: KW
authors.lastname: Millikan
authors.forename: Imke
authors.initials: I
authors.lastname: Janssen
authors.forename: Minh B
authors.initials: MB
authors.lastname: Luu
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006551:Hernia, Hiatal / Q000401:mortality / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D013526:Surgical Mesh; D015996:Survival Rate; D016896:Treatment Outcome