Department of Surgery, East Carolina University, Greenville, NC.
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
J Am Coll Surg. 2014 Jun;218(6):1187-92. doi: 10.1016/j.jamcollsurg.2013.12.058. Epub 2014 Feb 28.
Large studies have documented the safety of laparoscopic paraesophageal hernia (PEH) repair in the general population. Even though this condition affects primarily the elderly, data on the short-term outcomes of this procedure on the oldest-old are lacking.
The NSQIP database was analyzed for all patients undergoing laparoscopic PEH repair in 2010 and 2011. Chi-square, Fisher's exact, and 2-tailed Student's t-test were used to compare baseline characteristics, morbidity, and mortality. Binary logistic regression was used to control for confounding variables. Odds ratios (OR) with 95% confidence intervals (CI) were reported when applicable.
A total of 2,681 patients undergoing laparoscopic PEH repair were identified. The mean (±SD) age of the cohort was 63 ± 14 years. We identified 313 patients (11.7%) aged 80 years and older. Using regression analysis, advanced age (OR 1.7, 95% CI 1.1 to 2.7, p = 0.009), American Society of Anesthesiologists class 3 or 4 (OR 1.4, 95% CI 1.0 to 2.1, p = 0.045), gastrostomy placement (OR 2.4, 95% CI 1.3 to 4.7, p = 0.007), and significant recent weight loss (OR 2.1, 95% CI 1.1 to 4.1, p = 0.037) were independently associated with development of overall morbidity. Mortality (1% vs 0.4%, p = 0.16) and serious morbidity (5.8% vs 3.7%, p = 0.083) were not significantly different between the older and younger groups. Minor morbidity was higher in the older group (8.3% vs 3.5%, OR 2.5, 95% CI 1.6 to 3.9, p < 0.001).
In an assessment of modern nationwide practice, laparoscopic PEH repair is performed with minimal morbidity and mortality. Elective repair in patients aged 80 years or older is not associated with significant differences in mortality or major morbidity compared with younger patients.
大型研究已经证明了腹腔镜食管裂孔疝（PEH）修复术在普通人群中的安全性。尽管这种情况主要影响老年人，但缺乏关于该手术对最年长人群的短期结果的数据。
分析了 2010 年和 2011 年接受腹腔镜 PEH 修复术的所有患者的 NSQIP 数据库。使用卡方检验、Fisher 确切检验和双尾学生 t 检验比较基线特征、发病率和死亡率。使用二元逻辑回归控制混杂变量。当适用时，报告比值比（OR）和 95%置信区间（CI）。
共确定了 2681 例接受腹腔镜 PEH 修复术的患者。队列的平均（±SD）年龄为 63 ± 14 岁。我们确定了 313 名（11.7%）年龄在 80 岁及以上的患者。通过回归分析，高龄（OR 1.7，95%CI 1.1 至 2.7，p = 0.009）、美国麻醉医师协会（ASA）分级 3 或 4 级（OR 1.4，95%CI 1.0 至 2.1，p = 0.045）、胃造口术置放（OR 2.4，95%CI 1.3 至 4.7，p = 0.007）和近期显著体重减轻（OR 2.1，95%CI 1.1 至 4.1，p = 0.037）与总发病率的发展独立相关。死亡率（1%对 0.4%，p = 0.16）和严重发病率（5.8%对 3.7%，p = 0.083）在年龄较大和较小的组之间没有显著差异。年龄较大组的轻微发病率较高（8.3%对 3.5%，OR 2.5，95%CI 1.6 至 3.9，p < 0.001）。
在对现代全国性实践的评估中，腹腔镜 PEH 修复术具有最小的发病率和死亡率。与年轻患者相比，80 岁或以上患者的择期修复与死亡率或主要发病率无显著差异。
