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Defining surgical risk in octogenarians undergoing paraesophageal hernia repair

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

With an aging population, the utility of surgery in elderly patients, particularly octogenarians, is of increasing interest. The goal of this study was to analyze outcomes of octogenarians versus non-octogenarians undergoing paraesophageal hernia repair (PEHR).

Methods

The Nationwide Readmission Database was queried for patients > 18 years old who underwent PEHR from 2016 to 2018. Exclusion criteria included a diagnosis of gastrointestinal malignancy or a concurrent bariatric procedure. Patients ≥ 80 were compared to those 18–79 years old using standard statistical methods, and subgroup analyses of elective and non-elective PEHRs were performed.

Results

From 2016 to 2018, 46,450 patients were identified with 5425 (11.7%) octogenarians and 41,025 (88.3%) non-octogenarians. Octogenarians were more likely to have a non-elective operation (46.3% vs 18.2%, p < 0.001), and those undergoing non-elective PEHR had a higher mortality (5.5% vs 1.2%, p < 0.001). Outcomes were improved with elective PEHR, but octogenarians still had higher mortality (1.3% vs 0.2%, p < 0.001), longer LOS (3[2, 5] vs 2[1, 3] days, p < 0.001), and higher readmission rates within 30 days (11.1% vs 6.5%, p < 0.001) compared to non-octogenarian elective patients. Multivariable logistic regression showed that being an octogenarian was not independently predictive of mortality (odds ratio (OR) 1.373[95% confidence interval 0.962–1.959], p = 0.081), but a non-elective operation was (OR 3.180[2.492–4.057], p < 0.001). Being an octogenarian was a risk factor for readmission within 30 days (OR 1.512[1.348–1.697], p < 0.001).

Conclusions

Octogenarians represented a substantial proportion of patients undergoing PEHR and were more likely to undergo a non-elective operation. Being an octogenarian was not an independent predictor of perioperative mortality, but a non-elective operation was. Octogenarians' morbidity and mortality was reduced in elective procedures but was still higher than non-octogenarians. Elective PEHR in octogenarians is reasonable but should involve a thorough risk–benefit analysis.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA

    Hadley H. Wilson, Sullivan A. Ayuso, Mikayla Rose, Dau Ku, Gregory T. Scarola, Vedra A. Augenstein, Paul D. Colavita & B. Todd Heniford

Authors
  1. Hadley H. Wilson
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  2. Sullivan A. Ayuso
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  3. Mikayla Rose
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  4. Dau Ku
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  6. Vedra A. Augenstein
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  7. Paul D. Colavita
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Corresponding author

Correspondence to B. Todd Heniford.

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Disclosures

Dr. Paul Colavita has an investigator-initiated research grant with Medtronic. Dr. Vedra Augenstein receives speaking honoraria from Medtronic, Allergan, Intuitive, Acelity, and Bard. Dr. Todd Heniford receives surgical research and education grants and speaking honoraria from WL Gore and previously from Allergan. Dr. Hadley Wilson, Dr. Sullivan Ayuso, Ms. Mikayla Rose, Mr. Dau Ku, and Mr. Gregory Scarola have no disclosures to declare.

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Wilson, H.H., Ayuso, S.A., Rose, M. et al. Defining surgical risk in octogenarians undergoing paraesophageal hernia repair. Surg Endosc 37, 8644–8654 (2023). https://doi.org/10.1007/s00464-023-10270-z

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