Morbidity and mortality after antireflux and hiatal hernia surgery across a spectrum of ages.
Publication Title
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Document Type
Article
Publication Date
8-1-2024
Keywords
washington; swedish; swedish thoracic surgery; swedish digestive health; swedish cancer
Abstract
BACKGROUND: Antireflux surgery (ARS) and hiatal hernia repair (HHR) are common surgical procedures with modest morbidity. Increasing age is a risk factor for complications; however, details regarding acute morbidity are lacking. This study aimed to describe the incidence rates and types of morbidities across the spectrum of ages.
METHODS: A total of 2342 consecutive cases were retrospectively reviewed from 2003 to 2020 for 30-day complications. All complications were assessed using the Clavien-Dindo (CD) grading system. Patients were divided into 5 age groups: ?59, 60 to 69, 70 to 79, 80 to 89, and ?90 years.
RESULTS: The numbers per age group were 1100 patients aged ?59 years, 684 patients aged 60 to 69 years, 458 patients aged 70 to 79 years, 458 patients aged 80 to 89 years, and 6 patients aged ?90 years. A total of 427 complications (18.2%) occurred, including 2 mortalities, each in the 60- to 69-year age group and the 70- to 79-year age group, for a mortality rate of 0.2%. The complication rate increased from 13.5% (149) in patients aged ?59 years to 35.0% (35) in patients aged ?80 years (P = .006), with CD grades I and II accounting for >70% of complications, except in patients aged ?80 years (57.1%). CD grades IIIa and IIIb were higher in patients aged ?80 years (26.5% [P = .001] and 11.8% [P = .021], respectively). CD grade IVa and IVb complications were rare overall.
CONCLUSION: There is a modest rate of morbidity that increases as patients age, regardless of hernia type, elective or primary surgery, with most being minor complications (CD grade?II). Our data should help patients, referring physicians, and surgeons counsel patients regarding the effect of increasing age in ARS and HHR.
Clinical Institute
Digestive Health
Specialty/Research Institute
Gastroenterology
Specialty/Research Institute
Oncology
Specialty/Research Institute
Swedish Digestive Health Institute
DOI
10.1016/j.gassur.2024.05.033
