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Background <p>Hiatal hernia is an area of practice overlap between thoracic and general surgeons. Previous research has demonstrated comparable outcomes after laparoscopic repair by thoracic and general surgeons. However, their outcomes after open abdominal repair have not been compared. This study evaluated 30-day outcomes of open abdominal hiatal hernia repairs performed by thoracic and general surgeons in a&#xa0;large national database.</p> Methods <p>We included patients in the 2010–2022 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent open abdominal hiatal hernia repair. A&#xa0;1:3 propensity score matching (PSM) was conducted between cases performed by thoracic and general surgeons to address differences in demographics and baseline characteristics; 30-day outcomes were evaluated with univariate analysis.</p> Results <p>Among 5993 open abdominal hiatal hernia repairs, 366 (6.1%) were performed by thoracic surgeons. Patients treated by thoracic surgeons had more perioperative risk factors, including more advanced age and greater comorbidities. After 1:3 PSM, all 366 cases performed by thoracic surgeons were matched to 1075 performed by general surgeons. Patients treated by thoracic surgeons had comparable risks of 30-day mortality (2.5% vs. 2.4%; <i>p</i> = 1.00) and organ system complications. While the thoracic surgeon cohort had longer length of stay (7.6 ± 8.2 vs. 6.5 ± 8.9&#xa0;days; <i>p</i> = 0.04), all other 30-day outcomes were comparable.</p> Conclusion <p>Thoracic surgeons perform a&#xa0;minority of open abdominal hiatal hernia repairs and manage higher-risk and/or more complex cases. After PSM, 30-day morbidity and mortality for cases performed by thoracic and general surgeons were comparable. These findings demonstrate that hiatal hernia repair outcomes remain comparable between thoracic and general surgeons, regardless of an open or laparoscopic operative approach.</p>

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Thoracic and general surgeons have comparable 30-day outcomes for open abdominal hiatal hernia repair

  • 期刊论文

  • 发表日期：

    2025年8月28日

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  • Renxi Li,
  • Olivia Heutlinger,
  • Mira T. Tanenbaum,
  • Keith D. Mortman,
  • Sora Ely

摘要

Background

Hiatal hernia is an area of practice overlap between thoracic and general surgeons. Previous research has demonstrated comparable outcomes after laparoscopic repair by thoracic and general surgeons. However, their outcomes after open abdominal repair have not been compared. This study evaluated 30-day outcomes of open abdominal hiatal hernia repairs performed by thoracic and general surgeons in a large national database.

Methods

We included patients in the 2010–2022 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent open abdominal hiatal hernia repair. A 1:3 propensity score matching (PSM) was conducted between cases performed by thoracic and general surgeons to address differences in demographics and baseline characteristics; 30-day outcomes were evaluated with univariate analysis.

Results

Among 5993 open abdominal hiatal hernia repairs, 366 (6.1%) were performed by thoracic surgeons. Patients treated by thoracic surgeons had more perioperative risk factors, including more advanced age and greater comorbidities. After 1:3 PSM, all 366 cases performed by thoracic surgeons were matched to 1075 performed by general surgeons. Patients treated by thoracic surgeons had comparable risks of 30-day mortality (2.5% vs. 2.4%; p = 1.00) and organ system complications. While the thoracic surgeon cohort had longer length of stay (7.6 ± 8.2 vs. 6.5 ± 8.9 days; p = 0.04), all other 30-day outcomes were comparable.

Conclusion

Thoracic surgeons perform a minority of open abdominal hiatal hernia repairs and manage higher-risk and/or more complex cases. After PSM, 30-day morbidity and mortality for cases performed by thoracic and general surgeons were comparable. These findings demonstrate that hiatal hernia repair outcomes remain comparable between thoracic and general surgeons, regardless of an open or laparoscopic operative approach.