Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th floor, Philadelphia, PA, 19107, USA.
Surg Endosc. 2024 Jul;38(7):3999-4005. doi: 10.1007/s00464-024-10956-y. Epub 2024 Jun 10.
Hiatal hernia is a common surgical pathology. Such hernias can be found incidentally and patients may opt for an initial nonoperative approach though many will pursue surgery after symptom progression. Data on the effects of age on the outcomes of hiatal hernia repair may help inform this decision-making process.
The TriNetX database was queried for all adult patients undergoing hiatal hernia repair from 2000 to 2023. Patients were divided into elective and emergent cohorts on the basis of diagnosis codes indicating obstruction or gangrene. Patients aged 80-89 were compared against those aged 65-79 in unadjusted analysis. Logistic regression models controlling for additional health history covariates were created to calculate odds ratios for primary outcomes.
There were 2310 octogenarians and 15,295 seniors who underwent elective hiatal hernia repair, and 406 octogenarians and 1462 seniors who underwent emergent repair during the study period. The vast majority of patients in both groups underwent minimally invasive operations. In the elective cohort, octogenarians had higher rates of mortality, malnutrition, sepsis, respiratory failure, pneumonia, DVT, blood transfusion, and discharge to nursing facility. In the emergent cohort, octogenarians had higher rates of mortality, malnutrition, sepsis, and respiratory failure. The odds ratios for mortality in the elective and emergent cohorts were 3.9 (95% CI 3.1-5.0) and 3.5 (95% CI 2.1-5.6), respectively.
Octogenarians are at a meaningfully increased risk for mortality and morbidity after both elective and emergent hiatal hernia repair compared to senior-aged patients. Greater consideration should be given to surgical repair prior to the 8th decade of life.
食管裂孔疝是一种常见的外科病理学。这种疝可以偶然发现，患者可能选择初始非手术方法，尽管许多患者在症状进展后会选择手术。关于年龄对食管裂孔疝修补术结果的影响的数据可能有助于为这一决策过程提供信息。
从 2000 年到 2023 年，使用 TriNetX 数据库查询所有接受食管裂孔疝修补术的成年患者。根据提示梗阻或坏疽的诊断代码，患者被分为择期和紧急两组。在未调整分析中，将 80-89 岁的患者与 65-79 岁的患者进行比较。创建了包含其他健康史协变量的逻辑回归模型，以计算主要结局的优势比。
在研究期间，有 2310 名 80 岁以上的患者和 15295 名 65-79 岁的患者接受了择期食管裂孔疝修补术，有 406 名 80 岁以上的患者和 1462 名 65-79 岁的患者接受了紧急修补术。这两组患者绝大多数都接受了微创手术。在择期组中，80 岁以上患者的死亡率、营养不良、脓毒症、呼吸衰竭、肺炎、深静脉血栓形成、输血和转至护理院的比例更高。在紧急组中，80 岁以上患者的死亡率、营养不良、脓毒症和呼吸衰竭的比例更高。择期和紧急两组的死亡率优势比分别为 3.9（95%CI 3.1-5.0）和 3.5（95%CI 2.1-5.6）。
与 65-79 岁的老年患者相比，80 岁以上的患者在择期和紧急食管裂孔疝修补术后的死亡和发病风险显著增加。在 80 岁之前，应该更认真地考虑手术修复。
