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Laparoscopic Paraesophageal Hernia Repair in Patients Aged 80 and Older: No Difference in Serious Adverse Events or Mortality.
*Konstantinos Spaniolas, Thadeus L Trus, *Gina L Adrales, William S Laycock
Dartmouth-Hitchcock Medical Center, Lebanon, NH

Objective: The aim of this study was to assess the safety of laparoscopic paraesophageal hernia repair (LPEHR) in the patients aged ≥ 80 years (oldest-old).
Design: Cohort based on the ACS-NSQIP database.
Setting: Hospitals participating in NSQIP.
Patients: All patients who underwent LPEHR based on Current Procedural Terminology codes from January 2010 to December 2011 (N=2914). Subjects undergoing concurrent bariatric or emergent surgery were excluded.
Interventions: None.
Main Outcome Measures: 30-day crude mortality, serious and overall morbidity. Odds ratios (OR) with 95% confidence interval are presented when applicable.
Results: The mean age of the cohort was 63±14 years. We identified 313 patients (11.7%) aged 80 years and over. Using regression analysis, advanced age (OR 1.7, 1.1-2.7, p=0.009), ASA class 3 or 4 (OR 1.4, 1.0-2.1, p=0.045), gastrostomy placement (OR 2.4, 1.3-4.7, p=0.007) and significant recent weight loss (OR 2.1, 1.1-4.1, p=0.037) were independently associated with the development of overall morbidity. Mortality (1% vs 0.4%, p=0.16) and serious morbidity (5.8% vs 3.7%, p=0.083) were not significantly different between the older and younger groups. Minor morbidity was higher in the older group (8.3% vs 3.5%, OR 2.5, 1.6-3.9, p<0.001).
Conclusions: In an assessment of modern nationwide practice, LPEHR is performed with minimal morbidity and mortality. Elective repair in patients aged ≥ 80 years is not associated with significant difference in mortality or major morbidity compared to younger patients. The concurrent placement of gastrostomy in oldest-old patients warrants further evaluation.

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