Alyssa Brandt, Zachary Leslie, Mitch Rawson, Sayeed Ikramuddin, Eric Wise
{"title":"急诊与择期裂孔疝修补的发病率:NIS数据库的分析。","authors":"Alyssa Brandt, Zachary Leslie, Mitch Rawson, Sayeed Ikramuddin, Eric Wise","doi":"10.1007/s00464-025-11773-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Elective hiatal hernia repair (HHR) is associated with reduced morbidity compared to emergent HHR. However, few studies examine the specific factors contributing to morbidity in emergent HHR. This study uses the National Inpatient Sample (NIS) database to compare the morbidity of emergent versus non-emergent HHR and identify associated risk factors.</p><p><strong>Methods: </strong>Data from the NIS (2016-2021) were analyzed for all patients undergoing HHR. Health factors, including demographics, comorbidities, and operative details, were compared using chi-squared and T-tests. A multivariable logistic regression model was created to identify factors associated with morbidity, defined as postoperative complications such as sepsis, pneumonia, myocardial infarction, deep venous thrombosis (DVT), pulmonary embolism (PE), and others.</p><p><strong>Results: </strong>A total of 723,000 records existed with a hiatal hernia diagnosis code. Of these, 67,059 patients underwent HHR, with 61,586 (91.8%) undergoing non-emergent HHR. Emergent HHR was associated with increased morbidity (OR 3.95, 95% CI 1.0-1.05, p < 0.05). Risk factors for increased morbidity in both groups included hypertension and advanced age. Protective factors included female gender, GERD, and prior bariatric surgery. Diabetes increased morbidity in emergent HHR but not non-emergent HHR. Smoking, Medicare/Medicaid, mesh use, COPD, and history of DVT increased morbidity in elective HHR, but not emergent HHR. The robotic approach increased morbidity in non-emergent HHR but decreased it in emergent HHR.</p><p><strong>Conclusion: </strong>Emergent HHR is associated with higher morbidity compared to non-emergent HHR. Risk factors like smoking, COPD, and DVT increase morbidity in non-emergent HHR, while female gender, GERD, and prior bariatric surgery are protective. The NIS database provides valuable insights into the morbidity associated with HHR and can guide surgical decision-making.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3979-3985"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Morbidity of emergent versus elective hiatal hernia repair: an analysis of the NIS database.\",\"authors\":\"Alyssa Brandt, Zachary Leslie, Mitch Rawson, Sayeed Ikramuddin, Eric Wise\",\"doi\":\"10.1007/s00464-025-11773-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Elective hiatal hernia repair (HHR) is associated with reduced morbidity compared to emergent HHR. However, few studies examine the specific factors contributing to morbidity in emergent HHR. This study uses the National Inpatient Sample (NIS) database to compare the morbidity of emergent versus non-emergent HHR and identify associated risk factors.</p><p><strong>Methods: </strong>Data from the NIS (2016-2021) were analyzed for all patients undergoing HHR. Health factors, including demographics, comorbidities, and operative details, were compared using chi-squared and T-tests. A multivariable logistic regression model was created to identify factors associated with morbidity, defined as postoperative complications such as sepsis, pneumonia, myocardial infarction, deep venous thrombosis (DVT), pulmonary embolism (PE), and others.</p><p><strong>Results: </strong>A total of 723,000 records existed with a hiatal hernia diagnosis code. Of these, 67,059 patients underwent HHR, with 61,586 (91.8%) undergoing non-emergent HHR. Emergent HHR was associated with increased morbidity (OR 3.95, 95% CI 1.0-1.05, p < 0.05). Risk factors for increased morbidity in both groups included hypertension and advanced age. Protective factors included female gender, GERD, and prior bariatric surgery. Diabetes increased morbidity in emergent HHR but not non-emergent HHR. Smoking, Medicare/Medicaid, mesh use, COPD, and history of DVT increased morbidity in elective HHR, but not emergent HHR. The robotic approach increased morbidity in non-emergent HHR but decreased it in emergent HHR.</p><p><strong>Conclusion: </strong>Emergent HHR is associated with higher morbidity compared to non-emergent HHR. Risk factors like smoking, COPD, and DVT increase morbidity in non-emergent HHR, while female gender, GERD, and prior bariatric surgery are protective. The NIS database provides valuable insights into the morbidity associated with HHR and can guide surgical decision-making.</p>\",\"PeriodicalId\":22174,\"journal\":{\"name\":\"Surgical Endoscopy And Other Interventional Techniques\",\"volume\":\" \",\"pages\":\"3979-3985\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Endoscopy And Other Interventional Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00464-025-11773-7\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Endoscopy And Other Interventional Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00464-025-11773-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/9 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景:与紧急裂孔疝修补术相比,选择性裂孔疝修补术(HHR)的发病率更低。然而,很少有研究调查导致突发HHR发病率的具体因素。本研究使用国家住院病人样本(NIS)数据库来比较急诊和非急诊HHR的发病率,并确定相关的危险因素。方法:分析NIS(2016-2021)中所有HHR患者的数据。使用卡方检验和t检验比较健康因素,包括人口统计学、合并症和手术细节。建立了一个多变量logistic回归模型来确定与发病率相关的因素,定义为脓毒症、肺炎、心肌梗死、深静脉血栓形成(DVT)、肺栓塞(PE)等术后并发症。结果:裂孔疝诊断代码共记录72.3万份。其中,67,059例患者接受了HHR, 61,586例(91.8%)接受了非紧急HHR。紧急HHR与发病率增加相关(OR 3.95, 95% CI 1.0-1.05, p)结论:与非紧急HHR相比,紧急HHR与更高的发病率相关。吸烟、COPD和DVT等危险因素增加了非紧急HHR的发病率,而女性、GERD和既往减肥手术是保护因素。NIS数据库提供了与HHR相关的发病率的宝贵见解,并可以指导手术决策。
Morbidity of emergent versus elective hiatal hernia repair: an analysis of the NIS database.
Background: Elective hiatal hernia repair (HHR) is associated with reduced morbidity compared to emergent HHR. However, few studies examine the specific factors contributing to morbidity in emergent HHR. This study uses the National Inpatient Sample (NIS) database to compare the morbidity of emergent versus non-emergent HHR and identify associated risk factors.
Methods: Data from the NIS (2016-2021) were analyzed for all patients undergoing HHR. Health factors, including demographics, comorbidities, and operative details, were compared using chi-squared and T-tests. A multivariable logistic regression model was created to identify factors associated with morbidity, defined as postoperative complications such as sepsis, pneumonia, myocardial infarction, deep venous thrombosis (DVT), pulmonary embolism (PE), and others.
Results: A total of 723,000 records existed with a hiatal hernia diagnosis code. Of these, 67,059 patients underwent HHR, with 61,586 (91.8%) undergoing non-emergent HHR. Emergent HHR was associated with increased morbidity (OR 3.95, 95% CI 1.0-1.05, p < 0.05). Risk factors for increased morbidity in both groups included hypertension and advanced age. Protective factors included female gender, GERD, and prior bariatric surgery. Diabetes increased morbidity in emergent HHR but not non-emergent HHR. Smoking, Medicare/Medicaid, mesh use, COPD, and history of DVT increased morbidity in elective HHR, but not emergent HHR. The robotic approach increased morbidity in non-emergent HHR but decreased it in emergent HHR.
Conclusion: Emergent HHR is associated with higher morbidity compared to non-emergent HHR. Risk factors like smoking, COPD, and DVT increase morbidity in non-emergent HHR, while female gender, GERD, and prior bariatric surgery are protective. The NIS database provides valuable insights into the morbidity associated with HHR and can guide surgical decision-making.
期刊介绍:
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery