2023 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Montréal, Canada, 19 March–April 1 2023: Posters

Procedure volume impacts complications and length of stay (LOS) following emergent paraesophageal hernia repair Hadley H Wilson, MD; Dau Ku, MS; Gregory T Scarola, MSPH; Vedra A Augenstein, MD; Paul D Colavita; Todd Heniford, MD; Carolinas Medical Center

Introduction: Higher procedure volume has been associated with improved outcomes for a variety of procedures. This relationship has not been studied for most emergent procedures, including PEHR. Our goal was to utilize national data to evaluate the outcomes between high (HVC)- and low-volume centers (LVC) following emergent PEHR.

Methods and Procedures: The Nationwide Readmissions Database was queried for patients undergoing emergent PEHR from 2016 to 2018. Patients excluded were < 18 years old, diagnosed with gastrointestinal malignancy, or had a concurrent bariatric procedure. Centers were stratified into percentiles based on emergent procedure volume per year. HVCs were defined as the top 5th percentile (≥ 12 emergent procedures/year), and LVCs were defined as 50th percentile or less (≤ 2 emergent procedures/year). Standard statistical methods were applied.

Results: From 2016 to 2018, 9,966 patients were identified. Of these, 2,985(30.0%) underwent emergent PEHR at a HVC and 1,915(19.2%) at an LVC. Patients at HVCs were younger (67 [56, 76] vs 72 [61, 81] years, p < 0.001) and had a lower Charlson Comorbidity Index (0 [0, 1] vs 1 [0, 2], p < 0.001). HVC patients were more concentrated in metropolitan teaching (94.8% vs 51.2%, p < 0.001) and large( 88.7% vs 35.9%, p < 0.001) hospitals and were more often transferred from another facility (3.4% vs 1.6%, p < 0.001). Hospital charges were less at HVCs ($75,372 [40,835, 129,838] vs $85,852 [51,803, 148,270], p < 0.001). HVCs performed a higher proportion of laparoscopic (66.5% vs 57.5%, p < 0.001) and robotic(18.4% vs 9.5%,p  < 0.001) instead of open (14.5% vs 32.2%, p < 0.001) procedures. Rates of cardiac complications (13.6% vs 18.4%, p < 0.001), VTE( 1.7% vs 2.5%, p = 0.040), pneumonia ( 3.0% vs 6.1%, p < 0.001), respiratory failure (7.3% vs 13.9%, p < 0.001), acute renal failure (8.4% vs 17.3%, p < 0.001), and sepsis( 3.7% vs 9.0%, p < 0.001) were lower at HVCs. HVCs had lower LOS (4[2, 8] vs 7[4, 11] days, p < 0.001), 30-day( 10.2% vs 12.7%, p = 0.008), 90-day (14.7% vs 17.5%, p = 0.011), and 180-day (17.4% vs 20.7%, p = 0.005) readmission rates and perioperative mortality (1.6% vs 2.5%, p = 0.033). However, in regression, procedure volume was not independently associated with 30-day (p = 0.987), 90-day (p = 0.693), or 180-day (p = 0.537) readmissions or perioperative mortality (p = 0.727). Comorbidities (p < 0.001), payer type (p < 0.001), hospital bed size (p = 0.002), and LOS (p < 0.001) were independently associated with readmissions. Age, open procedure, and LOS (all p < 0.001) were independently associated with mortality. Procedure volume was independently associated with less overall complications(p = 0.046) and shorter LOS (p < 0.001).

Conclusion: After controlling for confounding variables, emergent PEHR procedure volume was not independently associated with readmissions or mortality, although it was independently associated with less complications and shorter LOS. Factors independently associated with readmissions included comorbidity burden, payer type, hospital bedsize, and LOS. Age, open procedure, and LOS were independently associated with mortality.

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