Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity.

Details

Serval ID
serval:BIB_9B736040F923
Type
Article: article from journal or magazin.
Collection
Publications
Title
Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity.
Journal
World Journal of Surgery
Author(s)
Larusson H.J., Zingg U., Hahnloser D., Delport K., Seifert B., Oertli D.
ISSN
0364-2313 (Print)
ISSN-L
0364-2313
Publication state
Published
Issued date
2009
Volume
33
Number
5
Pages
980-985
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
BACKGROUND: Patients undergoing laparoscopic paraesophageal hernia (PEH) repair risk substantial morbidity. The aim of the present study was to analyze predictive factors for postoperative morbidity and mortality.
METHODS: A total of 354 laparoscopic PEH repairs were analyzed from the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS). Age (<70 and > or =70 years) and risk (low: American Society of Anesthesiologists (ASA) scores 1 + 2; high ASA scores 3 + 4) groups were defined and multivariate logistic regression was conducted.
RESULTS: In patients > or =70 years of age postoperative morbidity (24.4% versus 10.1%; p = 0.001) and mortality (2.4% versus 0%; p = 0.045) were significantly higher than in patients <70 years of age. In patients with gastropexy, this significant age difference was again present (38.8% versus 10.5%; p = 0.001) whereas in patients with fundoplication no difference between age groups occurred (11.9% versus 10.1%; p = 0.65). Mortality did not differ. High-risk patients had a significantly higher morbidity (26.0% versus 11.2%; p = 0.001) but not mortality (2.1% versus 0.4%; p = 0.18). The multivariate logistic regression identified the following variables as influencing postoperative morbidity: Age > or =70 years (Odds Ratio [OR] 1.99 [95% CI 1.06 to 3.74], p = 0.033); ASA 3 + 4 (OR 2.29 [95% Confidence Interval (CI) 1.22 to 4.3]; p = 0.010); type of operation (gastropexy) (OR 2.36 [95% CI 1.27 to 4.37]; p = 0.006).
CONCLUSIONS: In patients undergoing laparoscopic paraesophageal hernia repair age, ASA score, and type of operation significantly influence postoperative morbidity and mortality. Morbidity is substantial among elderly patients and those with co-morbidity, questioning the paradigm for surgery in all patients. The indication for surgery must be carefully balanced against the individual patient's co-morbidities, age, and symptoms, and the potentially life threatening complications.
Keywords
Adult, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Female, Fundoplication/adverse effects, Fundoplication/methods, Hernia, Hiatal/diagnosis, Hernia, Hiatal/surgery, Humans, Laparoscopy/adverse effects, Laparoscopy/methods, Length of Stay/statistics & numerical data, Male, Middle Aged, Morbidity, Postoperative Complications/epidemiology, Prognosis, Prospective Studies, Risk Factors, Switzerland/epidemiology, Young Adult
Pubmed
Web of science
Create date
07/10/2014 15:17
Last modification date
20/08/2019 16:02
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