Abstract：
BACKGROUND: Hiatal hernia (HH) is estimated to affect between 20 and 50% of patients undergoing bariatric surgery. However, there is no consensus regarding the preoperative assessment and intraoperative repair of HH. The aim of this study was to evaluate the variation in surgeon assessment and repair of HH during bariatric surgery across a multi-hospital healthcare system.
METHODS: A retrospective cohort analysis was conducted using data obtained from the metabolic and bariatric accreditation quality improvement program (MBSAQIP) and institutional medical records. All adult patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were included. Preoperative assessment of HH was defined as either EGD or upper GI/Esophagram (UGI) within one year of surgery. Surgeons were evaluated individually and by hospital. Chi-square analysis and ANOVA were performed.
RESULTS: From January 2018 to February 2023, 3,487 bariatric surgeries were performed across 4 hospitals and 11 surgeons (2481 SG and 1006 RYGB). HH were concurrently repaired during 24% of operations. The rate of HH repair in SG was 25 and 22% in RYGB (p = 0.06). Preoperatively, 41% of patients underwent EGD and 23% had an UGI. HH was diagnosed in 22% of EGDs. Patients who underwent preoperative EGD had higher rates of HH repair than those without a preop EGD (33% vs. 17%; p < 0.001). The rate of preoperative EGD utilization by surgeon varied significantly from 3 to 92% (p < 0.001) as did HH repair rates between surgeons (range 8-57%; p < 0.001). Even among patients with a preoperatively diagnosed HH, the repair rate ranged 20-91% between individual surgeons (p < 0.001).
CONCLUSIONS: Within a healthcare system there was significant heterogeneity in approach to assessment and repair of HH during bariatric surgery. This appears to be mediated by multiple factors, including utilization of preoperative studies, individual surgeon differences, and differences between hospitals.
METHODS: A retrospective cohort analysis was conducted using data obtained from the metabolic and bariatric accreditation quality improvement program (MBSAQIP) and institutional medical records. All adult patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were included. Preoperative assessment of HH was defined as either EGD or upper GI/Esophagram (UGI) within one year of surgery. Surgeons were evaluated individually and by hospital. Chi-square analysis and ANOVA were performed.
RESULTS: From January 2018 to February 2023, 3,487 bariatric surgeries were performed across 4 hospitals and 11 surgeons (2481 SG and 1006 RYGB). HH were concurrently repaired during 24% of operations. The rate of HH repair in SG was 25 and 22% in RYGB (p = 0.06). Preoperatively, 41% of patients underwent EGD and 23% had an UGI. HH was diagnosed in 22% of EGDs. Patients who underwent preoperative EGD had higher rates of HH repair than those without a preop EGD (33% vs. 17%; p < 0.001). The rate of preoperative EGD utilization by surgeon varied significantly from 3 to 92% (p < 0.001) as did HH repair rates between surgeons (range 8-57%; p < 0.001). Even among patients with a preoperatively diagnosed HH, the repair rate ranged 20-91% between individual surgeons (p < 0.001).
CONCLUSIONS: Within a healthcare system there was significant heterogeneity in approach to assessment and repair of HH during bariatric surgery. This appears to be mediated by multiple factors, including utilization of preoperative studies, individual surgeon differences, and differences between hospitals.
摘要：
背景：据估计，食管裂孔疝（HH）会影响20％至50％的接受减肥手术的患者。然而,对于HH的术前评估和术中修复尚无共识.这项研究的目的是评估多医院医疗保健系统中减肥手术期间外科医生评估和HH修复的变化。
方法：使用从代谢和减肥认证质量改进计划（MBSAQIP）和机构医疗记录中获得的数据进行回顾性队列分析。包括所有接受腹腔镜袖状胃切除术（SG）或Roux-en-Y胃旁路术（RYGB）的成年患者。HH的术前评估定义为手术后一年内的EGD或上GI/食道（UGI）。单独和医院对外科医生进行评估。进行卡方分析和方差分析。
结果：从2018年1月到2023年2月，在4家医院和11名外科医生（2481SG和1006RYGB）中进行了3,487例减肥手术。在24%的手术中同时修复了HH。SG中的HH修复率为25％，RYGB中的HH修复率为22％（p=0.06）。术前,41%的患者接受了EGD，23%有UGI。在22％的EGD中诊断出HH。接受术前EGD的患者HH修复率高于没有术前EGD的患者(33%vs.17%；p<0.001)。术前EGD使用率从3％到92％（p<0.001），术前的HH修复率也有明显差异（范围为8-57％；p<0.001）。即使在术前诊断为HH的患者中，个别外科医生的修复率为20-91%(p<0.001).
结论：在医疗保健系统中，减肥手术期间HH的评估和修复方法存在显著的异质性。这似乎是由多种因素介导的，包括术前研究的利用，个别外科医生的差异，医院之间的差异。
方法：使用从代谢和减肥认证质量改进计划（MBSAQIP）和机构医疗记录中获得的数据进行回顾性队列分析。包括所有接受腹腔镜袖状胃切除术（SG）或Roux-en-Y胃旁路术（RYGB）的成年患者。HH的术前评估定义为手术后一年内的EGD或上GI/食道（UGI）。单独和医院对外科医生进行评估。进行卡方分析和方差分析。
结果：从2018年1月到2023年2月，在4家医院和11名外科医生（2481SG和1006RYGB）中进行了3,487例减肥手术。在24%的手术中同时修复了HH。SG中的HH修复率为25％，RYGB中的HH修复率为22％（p=0.06）。术前,41%的患者接受了EGD，23%有UGI。在22％的EGD中诊断出HH。接受术前EGD的患者HH修复率高于没有术前EGD的患者(33%vs.17%；p<0.001)。术前EGD使用率从3％到92％（p<0.001），术前的HH修复率也有明显差异（范围为8-57％；p<0.001）。即使在术前诊断为HH的患者中，个别外科医生的修复率为20-91%(p<0.001).
结论：在医疗保健系统中，减肥手术期间HH的评估和修复方法存在显著的异质性。这似乎是由多种因素介导的，包括术前研究的利用，个别外科医生的差异，医院之间的差异。
