Abstract
Background
Hiatal Hernia Repairs (HHR) are performed by both general surgeons (GS) and thoracic surgeons (TS). However, there are limited literature with respect to outcomes of HHR based on specialty training. The objective of this study was to compare the utilization, perioperative outcomes, and cost for HHR performed by GS versus TS.
Methods
The Vizient database was used to identify patients who underwent elective laparoscopic HHR between October 2014 and June 2018. Patients were grouped according to surgeon’s specialty (GS vs. TS). Patient demographics and outcomes including in-hospital mortality were compared between groups.
Results
During the study period 13,764 patients underwent HHR by either GS or TS. GS performed 9930 (72%) cases while TS performed 3834 (28%) cases. There was no significant difference between GS versus TS with regard to serious morbidity (1.28% vs. 1.30%, p = 0.97) or mortality (0.10% vs. 0.21%, p = 0.19). The mortality index was 0.24 for GS versus 0.45 for TS. Compared to TS, laparoscopic HHR performed by GS was associated with a shorter LOS (2.57 days vs. 2.72 days, p < 0.001) and lower mean hospital costs ($7139 vs. $8032, p < 0.0001).
Conclusions
Within the context of academic centers, laparoscopic HHRs are mostly performed by GS with comparable outcome between general versus thoracic surgeons.
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References
Smith BR, Hinojosa MW, Reavis KM, Nguyen NT (2008) Outcomes of esophagectomy according to surgeon’s training: general vs. thoracic. J Gastrointest Surg 12(11):1907–1911
Khoushhal Z, Canner J, Schneider E, Stem M, Haut E, Mungo B et al (2016) Influence of specialty training and trainee involvement on perioperative outcomes of esophagectomy. Ann Thorac Surg 102(6):1829–1836
Khoshhal Z, Canner J, Schneider E, Stem M, Haut E, Schlottmann F et al (2017) Impact of surgeon specialty on perioperative outcomes of surgery for benign esophageal diseases: a NSQIP analysis. J Laparoendosc Adv Surg Tech Part A 27(9):924–930
Lieber BA, Henry JK, Agarwal N, Day JD, Morris TW 3rd, Stephens ML et al (2017) Impact of surgical specialty on outcomes following carotid endarterectomy. Neurosurgery 80(2):217–225
Silvestri GA, Handy J, Lackland D, Corley E, Reed CE (1998) Specialists achieve better outcomes than generalists for lung cancer surgery. Chest 114(3):675–680
Mungo B, Molena D, Stem M, Feinberg RL, Lidor AO (2014) Thirty-day outcomes of paraesophageal hernia repair using the NSQIP database: should laparoscopy be the standard of care? J Am Coll Surg 219(2):229–236
Latzko M, Borao F, Squillaro A, Mansson J, Barker W, Baker T (2014) Laparoscopic repair of paraesophageal hernias. JSLS 18(3):5
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Ninh T. Nguyen received honorarium as a speaker for Covidien, Gore, Novadaq, and Olympus. Brian R. Smith received honorarium as an educational consultant for Stryker Endoscopy. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. All authors have approved the final article. Sahil Gambhir, Shaun Daly, Shelley Maithel, Brian M. Sheehan, James Nguyen, and Marcelo W. Hinojosa have no conflicts of interest or financial ties to disclose.
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Gambhir, S., Daly, S., Maithel, S. et al. Outcomes of laparoscopic hiatal hernia repair based on surgical specialty: thoracic versus general surgeons. Surg Endosc 34, 1621–1624 (2020). https://doi.org/10.1007/s00464-019-06926-4
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DOI: https://doi.org/10.1007/s00464-019-06926-4