Surg Endosc. 2026 Jun 8. doi: 10.1007/s00464-026-12944-w. Online ahead of print.
ABSTRACT
BACKGROUND: National database studies suggest elective paraesophageal hernia (PEH) repair in octogenarians is safe but provide limited detail on operative strategy and long-term symptom outcomes. We evaluated perioperative outcomes, operative strategy, and post-discharge functional outcomes in octogenarians undergoing PEH repair compared with younger patients in a contemporary institutional cohort.
METHODS: A retrospective review of 2,517 PEH repairs performed at a tertiary academic center from 2010-2023 was conducted. Patients were stratified by age (18-79 vs. ≥ 80 years). Demographics, operative characteristics, 30-day complications, recurrence, reoperation, and postoperative symptoms were compared. Multivariable logistic regression identified predictors of composite adverse outcome (CAO), defined as postoperative GERD, dysphagia, recurrence, or reoperation.
RESULTS: Of 2,517 patients, 195 (7.7%) were ≥ 80 years. Compared with younger patients, octogenarians had lower BMI (26.9 vs. 32.5 kg/m2, p < 0.001), higher rates of cardiovascular disease (83.6% vs. 61.0%, p < 0.001), and more frequent ASA ≥ III (93.2% vs. 69.6% p < 0.001). Non-elective surgery was more common in octogenarians (30.6% vs. 6.0%, p < 0.001). Surgeons performed gastropexy more than twice as often in octogenarians (43.6% vs. 17.3%, p < 0.001) and used mesh reinforcement at higher rates (21.5% vs. 13.0%, p = 0.004), while fundoplication rates were similar (33.3% vs. 38.7%, p = 0.12). Thirty-day complications were higher in octogenarians (15.9% vs. 9.1%, p = 0.006), with no significant difference in mortality (1.0% vs. 0.3%, p = 0.15). Hernia recurrence, postoperative GERD, dysphagia, and reoperation were similar between groups (p > 0.05 for all). Age ≥ 80 was not independently associated with CAO (OR 1.05, 95% CI 0.72-1.54, p = 0.79).
CONCLUSIONS: PEH repair in octogenarians is associated with increased perioperative morbidity but similar PEH-related outcomes compared with younger patients. These findings support consideration of elective repair in appropriately selected symptomatic octogenarians and individualized risk assessment based on comorbidities rather than age alone.
PMID:42260173 | DOI:10.1007/s00464-026-12944-w