Abstract
BackgroundHiatal hernia repair is commonly performed by both general and thoracic surgeons. The present study examined differences in approach, setting, and outcomes by specialty for hiatal hernia repair. MethodsAdults undergoing hiatal hernia repair were identified in the 2012–2019 American College of Surgeons National Surgical Quality Improvement Program. Patients were grouped by specialty of the operating surgeon (thoracic surgery vs general surgery). Generalized linear models were used to evaluate the effect of specialty on mortality, major morbidity, and 30-day readmission. ResultsAmong 46,739 patients, 5.0% were operated on by thoracic surgery. General surgery operated on younger patients (44.7 years vs 47.0, P < .001) with lesser systemic illness (American Society of Anesthesiologists class ≥3 50.4% vs 54.8%, P < .001) compared to thoracic surgery. General surgery more commonly used laparoscopy (95.0% vs 82.6%) and less commonly used thoracic approaches than thoracic surgery (0.6% vs 8.5%, P < .001). From 2012 to 2019, the proportion of cases performed as an outpatient by general surgery increased (28.1% to 46.4%, P < .001), but it remained stable for thoracic surgery (0.1% to 0.7%, P = .10). After risk adjustment, thoracic surgery specialty was not associated with mortality (odds ratio 0.9, 95% confidence interval 0.5–1.5), major morbidity (0.9, 95% confidence interval 0.7–1.1), or readmission (0.9, 95% confidence interval 0.8–1.1). Rather, factors including surgical approach (laparotomy 1.6, 95% confidence interval 1.4–1.9; thoracoscopy/thoracotomy 2.0, 95% confidence interval 1.5–2.7), inpatient case status (2.4, 95% confidence interval 2.2–2.7), increasing ASA class, and functional status more strongly influenced major morbidity. ConclusionOperative factors, surgical approach, and patient comorbidities more strongly influence outcomes of hiatal hernia repair than does surgeon specialty, suggesting continued safety of hiatal hernia repair by both thoracic and general surgeons.
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