Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA.
Surg Endosc. 2018 Nov;32(11):4666-4672. doi: 10.1007/s00464-018-6311-0. Epub 2018 Jun 22.
Patients with a paraesophageal hernia may experience gastroesophageal reflux symptoms and/or obstructive symptoms such as dysphagia. Some patients with large and complex paraesophageal hernias unintentionally lose a significant amount of weight secondary to difficulty eating. A subset of patients will develop Cameron's erosions in the hernia, which contribute to anemia. Given the heterogeneous nature of patients who ultimately undergo paraesophageal hernia repair, we sought to determine if patients with anemia or malnutrition suffered from increased morbidity or mortality.
The American College of Surgeons National Surgical Quality Improvement Program datasets from 2011 to 2015 were queried to identify patients undergoing paraesophageal hernia repair. Malnutrition was defined as preoperative albumin < 3.5 g/dL. Preoperative anemia was defined as hematocrit less than 36% for females and 39% for males. Thirty-day postoperative outcomes were assessed.
A total of 15,105 patients underwent paraesophageal hernia repair in the study interval. Of these patients, 7943 (52.6%) had a recorded preoperative albumin and 13.9% of these patients were malnourished. There were 13,139 (87%) patients with a documented preoperative hematocrit and 23.1% met criteria for anemia. Both anemia and malnutrition were associated with higher rates of complications, readmissions, reoperations, and mortality. This was confirmed on logistic regression. The average postoperative length of stay was longer in the malnourished (6.1 vs. 3.1 days when not malnourished, p < 0.0001) and anemic (4.1 vs. 2.8 days without anemia, p < 0.0001).
Malnutrition and anemia are associated with increased morbidity and mortality in patients undergoing paraesophageal hernia repair, as well as a longer length of stay. This information can be used for risk assessment and perhaps preoperative optimization of these risk factors when clinically appropriate.
食管裂孔疝患者可能会出现胃食管反流症状和/或阻塞症状，如吞咽困难。一些患有大而复杂食管裂孔疝的患者因进食困难而意外减重。一些患者会在疝中出现 Cameron 糜烂，导致贫血。鉴于最终接受食管裂孔疝修补术的患者具有异质性，我们试图确定贫血或营养不良的患者是否会出现更高的发病率或死亡率。
从 2011 年至 2015 年，查询美国外科医师学院国家外科质量改进计划数据集，以确定接受食管裂孔疝修补术的患者。营养不良定义为术前白蛋白<3.5 g/dL。术前贫血定义为女性红细胞压积<36%，男性红细胞压积<39%。评估术后 30 天的结果。
在研究期间，共有 15105 名患者接受了食管裂孔疝修补术。这些患者中有 7943 名（52.6%）记录了术前白蛋白，其中 13.9%存在营养不良。有 13139 名（87%）患者有术前红细胞压积记录，其中 23.1%符合贫血标准。贫血和营养不良均与更高的并发症、再入院、再次手术和死亡率相关。这在逻辑回归中得到了证实。营养不良组的术后平均住院时间较长（6.1 天 vs. 不营养不良组的 3.1 天，p<0.0001），贫血组（4.1 天 vs. 无贫血组的 2.8 天，p<0.0001）。
在接受食管裂孔疝修补术的患者中，营养不良和贫血与发病率和死亡率增加以及住院时间延长有关。这些信息可用于风险评估，并且在临床适当的情况下，可能用于术前这些危险因素的优化。
