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Background <p>Paraesophageal hernias exhibit diverse anatomical variations, and while elective repair is standard for symptomatic cases, larger Types II–IV hernias can necessitate emergent intervention. Despite a recognized demographic trend in emergent cases, a consensus on post-operative outcomes is lacking. This study aims to assess the 30-day post-operative outcomes of elective and emergent laparoscopic paraesophageal hernia (PEH) repair.</p> Methods <p>This analysis queried the ACS-NSQIP database from 2011 to 2020, focusing on elective and emergent laparoscopic PEH repairs. Procedures resulting in any resection or conversion to open were excluded. A propensity score matching analysis with a 1:4 ratio was conducted to assess 30-day post-operative outcomes between elective and emergent laparoscopic paraesophageal hernia repair. Additional sensitivity analyses across multiple matching ratios (1:1 to 1:6) and multivariable logistic regression were performed to evaluate the robustness of the initial findings.</p> Results <p>Eight hundred and four patients underwent emergent laparoscopic PEH repair and 36,926 patients underwent elective repair. Patients who underwent emergent repair were significantly older (<i>p</i> &lt; 0.0001) with lower BMI (<i>p</i> &lt; 0.0001). On propensity score-matched analysis, emergent cases were associated with a significantly higher risk of sepsis (<i>p</i> &lt; 0.0001), infection (<i>p</i> = .0030), transfusion (<i>p</i> &lt; 0.0001), reoperation (<i>p</i> = .0020), longer length of stay (<i>p</i> &lt; 0.0001), pulmonary complications (<i>p</i> &lt; 0.0001), and renal complications (<i>p</i> = .0002).</p> Conclusion <p>Despite the existing literature’s discordant findings, our study showed that emergent laparoscopic PEH repairs are associated with significantly worse 30-day outcomes compared to elective laparoscopic PEH repairs. The higher rates of post-operative complications in emergent cases emphasize the need for careful patient selection and procedural planning. Temporizing measures with planned staged repair can be considered a potential strategy in emergent cases.</p>

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Emergent laparoscopic paraesophageal hernia repairs are associated with an increased risk of 30-day post-operative complications: a NSQIP analysis

  • 期刊论文

  • 发表日期：

    2025年9月8日

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  • Alex I. Halpern,
  • Hope T. Jackson,
  • Victoria O. Haney,
  • Benjamin McSweeney,
  • Romtin Nadjafi,
  • Seyedeh A. Miran,
  • Phillip Ma,
  • Juliet Lee,
  • Khashayar Vaziri

摘要

Background

Paraesophageal hernias exhibit diverse anatomical variations, and while elective repair is standard for symptomatic cases, larger Types II–IV hernias can necessitate emergent intervention. Despite a recognized demographic trend in emergent cases, a consensus on post-operative outcomes is lacking. This study aims to assess the 30-day post-operative outcomes of elective and emergent laparoscopic paraesophageal hernia (PEH) repair.

Methods

This analysis queried the ACS-NSQIP database from 2011 to 2020, focusing on elective and emergent laparoscopic PEH repairs. Procedures resulting in any resection or conversion to open were excluded. A propensity score matching analysis with a 1:4 ratio was conducted to assess 30-day post-operative outcomes between elective and emergent laparoscopic paraesophageal hernia repair. Additional sensitivity analyses across multiple matching ratios (1:1 to 1:6) and multivariable logistic regression were performed to evaluate the robustness of the initial findings.

Results

Eight hundred and four patients underwent emergent laparoscopic PEH repair and 36,926 patients underwent elective repair. Patients who underwent emergent repair were significantly older (p < 0.0001) with lower BMI (p < 0.0001). On propensity score-matched analysis, emergent cases were associated with a significantly higher risk of sepsis (p < 0.0001), infection (p = .0030), transfusion (p < 0.0001), reoperation (p = .0020), longer length of stay (p < 0.0001), pulmonary complications (p < 0.0001), and renal complications (p = .0002).

Conclusion

Despite the existing literature’s discordant findings, our study showed that emergent laparoscopic PEH repairs are associated with significantly worse 30-day outcomes compared to elective laparoscopic PEH repairs. The higher rates of post-operative complications in emergent cases emphasize the need for careful patient selection and procedural planning. Temporizing measures with planned staged repair can be considered a potential strategy in emergent cases.