Poulose Benjamin K, Gosen Christine, Marks Jeffrey M, Khaitan Leena, Rosen Michael J, Onders Raymond P, Trunzo Joseph A, Ponsky Jeffrey L
Department of Surgery, University Hospitals Case Medical Center, Lakeside 7010, Mailstop 5047, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
J Gastrointest Surg. 2008 Nov;12(11):1888-92. doi: 10.1007/s11605-008-0625-5. Epub 2008 Aug 14.
Paraesophageal hernia repair is often performed in an elderly population. Few studies have evaluated perioperative mortality in this group. We identified predictors of inpatient mortality using a nationally representative sample.
Patients >/=80 years old undergoing transabdominal paraesophageal hernia repair were identified in the 2005 Nationwide Inpatient Sample. Congenital diaphragmatic defects and traumatic injuries were excluded.
One thousand five discharges (73% female) with mean age 84.7 met inclusion criteria. Mean length of stay was 10.1 days (95% confidence interval 8.9-11.3) with a mortality of 8.2%. Non-elective repair was performed in 43%. For these patients, mortality and mean length of stay (16%; 14.3 days) were increased compared to elective repair (2.5%; 7.0 days, p < 0.05). Non-elective repair was the sole predictor of inpatient mortality in adjusted analyses (odds ratio 7.1, 95% confidence interval 1.9-26.3, p < 0.05).
Non-elective repair was associated with a six to sevenfold increase in mortality and longer length of stay. Earlier elective repair of paraesophageal hernia may reduce mortality.
食管旁疝修补术常在老年人群中进行。很少有研究评估该群体的围手术期死亡率。我们使用全国代表性样本确定了住院死亡率的预测因素。
在2005年全国住院患者样本中确定年龄≥80岁接受经腹食管旁疝修补术的患者。排除先天性膈缺陷和创伤性损伤。
1500例出院患者（73%为女性）符合纳入标准，平均年龄84.7岁。平均住院时间为10.1天（95%置信区间8.9 - 11.3），死亡率为8.2%。43%的患者进行了非择期修补。与择期修补相比（2.5%；7.0天，p < 0.05），这些患者的死亡率和平均住院时间增加（分别为16%；14.3天）。在调整分析中，非择期修补是住院死亡率的唯一预测因素（比值比7.1，95%置信区间1.9 - 26.3，p < 0.05）。
非择期修补与死亡率增加6至7倍和住院时间延长有关。早期择期修补食管旁疝可能降低死亡率。
