Oc-059 paraesophageal hernia repair (pehr) in octogenarians: the risks of watchful waiting versus elective repair

Abstract Introduction With an aging population, the utility of surgery in elderly patients, particularly octogenarians, is of increasing interest. Our goal was to analyze outcomes of those over 80 versus younger patients. Methods The Nationwide Readmission Database was queried for patients who underwent PEHR from 2016–2018. Exclusions included diagnosis of gastrointestinal malignancy, concurrent bariatric procedure, or age <18. Patients 380 were compared to those 18–79 years old using standard statistical methods, with subgroup analysis of elective PEHR. Results From 2016–2018, 46,450 patients were identified: 5,425(11.7%) were 380 years old and 41,025(88.3%) were <80 years old. The median age of octogenarians was 84[81, 87] and of younger patients was 64[54, 71]. Octogenarians were more likely to have an emergency operation(46.3% vs 18.2%,p<0.001). Multivariable logistic regression revealed age380 was an independent predictor of readmissions at 30(OR=1.512[1.348–1.697],p<0.001), 90(OR=1.451[1.314–1.603],p<0.001), and 180(OR=1.471[1.341–1.613],p<0.001) days but not of perioperative mortality(OR=1.373[0.962–1.959],p=0.081). Emergency procedure was an independent predictor of mortality for all patients(OR=3.180[2.492–4.057],p<0.001). For only elective procedures, octogenarians had higher mortality(1.3% vs 0.2%,p<0.001), longer LOS (3[2, 5] vs 2[1, 3] days,p<0.001), and higher readmission rates at 30(11.1% vs 6.5%,p<0.001), 90(16.0% vs 9.4%,p<0.001), and 180(19.4% vs 11.5%,p<0.001) days. Conclusions Octogenarians represented a substantial proportion of patients undergoing PEHR and were more likely to undergo an emergent operation. Being an octogenarian was not an independent predictor of perioperative mortality, but emergency status was. Octogenarians’ perioperative mortality rate was reduced in elective procedures but was still higher than younger patients. The decision for elective repair should involve a thorough risk/benefit analysis in octogenarians.