Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA. Electronic address: https://twitter.com/CoreLabUCLA.
Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA.
Surgery. 2022 Aug;172(2):734-740. doi: 10.1016/j.surg.2022.03.044. Epub 2022 May 18.
Hiatal hernia repair is commonly performed by both general and thoracic surgeons. The present study examined differences in approach, setting, and outcomes by specialty for hiatal hernia repair.
Adults undergoing hiatal hernia repair were identified in the 2012-2019 American College of Surgeons National Surgical Quality Improvement Program. Patients were grouped by specialty of the operating surgeon (thoracic surgery vs general surgery). Generalized linear models were used to evaluate the effect of specialty on mortality, major morbidity, and 30-day readmission.
Among 46,739 patients, 5.0% were operated on by thoracic surgery. General surgery operated on younger patients (44.7 years vs 47.0, P < .001) with lesser systemic illness (American Society of Anesthesiologists class ≥3 50.4% vs 54.8%, P < .001) compared to thoracic surgery. General surgery more commonly used laparoscopy (95.0% vs 82.6%) and less commonly used thoracic approaches than thoracic surgery (0.6% vs 8.5%, P < .001). From 2012 to 2019, the proportion of cases performed as an outpatient by general surgery increased (28.1% to 46.4%, P < .001), but it remained stable for thoracic surgery (0.1% to 0.7%, P = .10). After risk adjustment, thoracic surgery specialty was not associated with mortality (odds ratio 0.9, 95% confidence interval 0.5-1.5), major morbidity (0.9, 95% confidence interval 0.7-1.1), or readmission (0.9, 95% confidence interval 0.8-1.1). Rather, factors including surgical approach (laparotomy 1.6, 95% confidence interval 1.4-1.9; thoracoscopy/thoracotomy 2.0, 95% confidence interval 1.5-2.7), inpatient case status (2.4, 95% confidence interval 2.2-2.7), increasing ASA class, and functional status more strongly influenced major morbidity.
Operative factors, surgical approach, and patient comorbidities more strongly influence outcomes of hiatal hernia repair than does surgeon specialty, suggesting continued safety of hiatal hernia repair by both thoracic and general surgeons.
食管裂孔疝修复术通常由普通外科医生和胸外科医生进行。本研究通过专业知识来检查食管裂孔疝修复术的方法、环境和结果的差异。
在 2012 年至 2019 年期间，美国外科医师学院国家外科质量改进计划确定了接受食管裂孔疝修复术的成年人。根据手术医生的专业知识（胸外科与普通外科）将患者分组。使用广义线性模型评估专业知识对死亡率、主要发病率和 30 天再入院的影响。
在 46739 名患者中，5.0%由胸外科医生进行手术。与胸外科相比，普通外科手术的患者年龄更小（44.7 岁 vs 47.0 岁，P <.001），全身疾病较少（美国麻醉医师协会分类≥3 级 50.4% vs 54.8%，P <.001）。与胸外科相比，普通外科更常使用腹腔镜（95.0% vs 82.6%），而较少使用胸腔入路（0.6% vs 8.5%，P <.001）。从 2012 年到 2019 年，普通外科作为门诊手术的比例增加（28.1%至 46.4%，P <.001），但胸外科的比例保持稳定（0.1%至 0.7%，P =.10）。在风险调整后，胸外科专业与死亡率（优势比 0.9，95%置信区间 0.5-1.5）、主要发病率（0.9，95%置信区间 0.7-1.1）或再入院率（0.9，95%置信区间 0.8-1.1）无关。相反，手术方法（剖腹手术 1.6，95%置信区间 1.4-1.9；腹腔镜/胸腔镜手术 2.0，95%置信区间 1.5-2.7）、住院病例状态（2.4，95%置信区间 2.2-2.7）、美国麻醉医师协会分类增加和功能状态等因素对主要发病率的影响更大。
手术因素、手术方法和患者合并症比外科医生的专业知识更能影响食管裂孔疝修复术的结果，这表明胸外科医生和普通外科医生进行食管裂孔疝修复术的安全性仍然很高。
