Ivy Megan L, Baison George, Griffin Cassandra, Welch Allison C, White Peter T, Farivar Alexander S, Bograd Adam J, Aye Ralph W, Louie Brian E
From the Division of Thoracic Surgery, Providence-Swedish Medical Center, Seattle, WA.
J Am Coll Surg. 2024 Oct 1;239(4):323-332. doi: 10.1097/XCS.0000000000001114. Epub 2024 Sep 16.
The historic morbidity and mortality rates of antireflux and hiatal hernia operation are reported as 3% to 21% and 0.2% to 0.5%, respectively. These data come from either large national and population level or small institutional studies, with the former focusing on broad 30-day outcomes while lacking granular data on complications and their severity. Institutional studies tend to focus on long-term and quality-of-life outcomes. Our objective is to describe and evaluate the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset.
We retrospectively reviewed 2,342 cases of antireflux and hiatal hernia operation from 2003 to 2020 for intraoperative complications causing postoperative sequelae, as well as morbidity and mortality within 90 days. All complications were graded using the Clavien-Dindo (CD) grading system. The highest grade of complication was used per patient during 30- and 31- to 90-day intervals.
Of 2,342 patients, the overall 30-day morbidity and mortality rates were 18.2% (427 of 2,342) and 0.2% (4 of 2,342), respectively. Most of the complications were CD less than 3a at 13.1% (306 of 2,342). In the 31- to 90-day postoperative period, morbidity and mortality rates decreased to 3.1% (78 of 2,338) and 0.09% (2 of 2,338). CD less than 3a complications accounted for 1.9% (42 of 2,338).
Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity. However, the majority of complications patients experience are minor (CD less than 3a) and are easily managed. A minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent.
据报道，抗反流手术和食管裂孔疝手术的历史发病率和死亡率分别为3%至21%和0.2%至0.5%。这些数据来自大型国家和人群层面的研究或小型机构研究，前者侧重于宽泛的30天结局，而缺乏关于并发症及其严重程度的详细数据。机构研究往往侧重于长期和生活质量结局。我们的目的是描述和评估一个大型单机构数据集中30天和90天发病率及死亡率。
我们回顾性分析了2003年至2020年期间2342例抗反流手术和食管裂孔疝手术病例，以查找导致术后后遗症的术中并发症以及90天内的发病率和死亡率。所有并发症均使用Clavien-Dindo（CD）分级系统进行分级。在30天和31至90天期间，每位患者采用最高级别的并发症。
在2342例患者中，总体30天发病率和死亡率分别为18.2%（2342例中的427例）和0.2%（2342例中的4例）。大多数并发症为CD小于3a级，占13.1%（2342例中的306例）。在术后31至90天期间，发病率和死亡率分别降至3.1%（2338例中的78例）和0.09%（2338例中的2例）。CD小于3a级并发症占1.9%（2338例中的42例）。
抗反流手术和食管裂孔疝手术是安全的，死亡率低，发病率适中。然而，患者经历的大多数并发症为轻微并发症（CD小于3a级），易于处理。少数患者会经历严重并发症（CD 3a级或更高），需要额外的手术和管理以确保安全结局。这些数据有助于告知患者手术风险，并指导医生进行最佳的知情同意。
