National Trends in Emergent Paraesophageal Hernia Repair Over 8 Years

BackgroundEmergent paraesophageal hernia repair (emPEHR) may be required due to complications such as incarceration or gastric volvulus. However, data regarding changes in management and outcomes of emPEHR is limited. Our objective was to evaluate national trends in emPEHR over an 8-year period.MethodsThe 2015-2022 ACS-NSQIP databases were queried for cases of emPEHR using Current Procedural Terminology (CPT) codes. Trends in patient demographics, operative characteristics, and 30-day postoperative outcomes were evaluated.ResultsA total of 42 476 cases of PEHR were performed during the study period. Of these, 1583 (3.7%) were emergent. The proportion of emPEHR cases has increased from 2015 to 2022 (3.1% to 5.6%, P < 0.001). Utilization of laparoscopy has increased from 60.3% to 79.1% (P < 0.001). Emergent cases had a higher likelihood of wound (OR 4.0, P < 0.001), pulmonary (OR 4.5, P < 0.001), neurovascular (OR 3.9, P < 0.001), renal (OR 2.5, P < 0.001), and cardiac (OR 2.0, P < 0.001) complications, sepsis (OR 6.4, P < 0.001), reoperation (OR 1.9, P < 0.001), readmission (OR 1.5, P < 0.001), and mortality (OR 4.5, P < 0.001) compared to elective cases. However, between, there was a decrease in renal complications (6.9% to 1.7%, P = 0.004) and bleeding requiring transfusions (6.9% to 3.7%, P < 0.001) following emPEHR.DiscussionThere has been an increase in rates of emergent PEHR since 2015. Emergent cases have poorer outcomes compared to elective cases, with only a minimal decrease in certain postoperative complications over time. This data highlights the importance of elective repair for PEHs and the need to proactively identify patients who will benefit from elective repair or specialist referral.