Does Age Impact Risk of Morbidity and Mortality for Elective Paraesophageal Hernia Repair in the Era of Minimally-Invasive Repair?

Purpose: Patients with paraesophageal hernias (PEHs) typically present in the sixth and seventh decades of life. Frequently, elderly patients are not offered elective repair due to historical data on high operative risk. Given the broad adoption of minimally-invasive (MIS) techniques, we hypothesized that risk would be more acceptable in elderly patients. Methods: A retrospective study of the National Inpatient Sample (NIS) from 2016 to 2018 was performed. Patients were divided by age (50–79 and ≥80 years) and compared using Pearson’s Chi-squared and Student’s t-tests. Propensity score-match using age, race, gastroesophageal reflux disease, frailty, and 11 comorbidities was performed. Results: 10 456 patients were included, 90.4% 50–79 (9,454) and 9.6% ≥ 80 (1002). The cohort was predominantly female (76.3%). Younger patients had fewer overall comorbidities and lower likelihood of frailty (2.5% vs. 9.3%, P < .01). Younger patients had shorter lengths of stay (2 days vs. 3 days, P < .01), fewer overall complications (26% vs. 36.8%, P < .01), and major complications (20.8% vs. 29.2%, P < .01). In-hospital mortality was higher for those over 80 (0.3% vs. 2.3%, P < .01). Propensity matching selected 942 pairs. Age remained associated with more frequent minor complications (23% vs. 28.7%, P < .01), major complications (12.1% vs. 16.1%, P < 0.01), and in-hospital mortality (0.5% vs. 2.3%, P < .01). Conclusions: There remains a significant association between age and risk of minor complication, major complication, and in-hospital mortality for elective repair of PEH despite the broad adoption of MIS techniques. This data may support the elective repair of PEHs at a younger age.