The Epidemiology of Surgically Managed Hiatal Hernia: A Nine Year Review of National Trends

Background: National-level data on the burden of disease related to surgically managed hiatal hernia (HH) is not available. This study intends to define this burden of disease in the United States with attention to patient demographics, surgical approach, readmissions, mortality, and charges. Methods: Data from national Healthcare Utilization Project (HCUP) databases for 2010-2018 were retrospectively reviewed. Adult patients undergoing elective or emergent non-congenital diaphragmatic hernia repair were included. Spearman’s rank correlation was utilized to determine significance of trends over time. Results: In 2018, an estimated 62 528 HH repairs were performed, an incidence of 19.14/100 000 persons per year. The non-ambulatory procedure incidence was 7.52/100 000 persons in 2010 compared to 12.76/100 000 persons in 2018. Between the first and final years of analysis, patients undergoing non-elective repairs increased in age (2010: 62 years vs 2018: 69 years, P < .01) and frailty (4.9% vs 16.3%, P < .01). Rates of 30-day readmission remained similar for elective (6.5% vs 5.7%, P = .06) and non-elective operations (9.9% vs 9.5%, P = .71). In-hospital mortality increased for elective repairs (0.3% vs 0.6%, P < .01). In the final year of analysis, median charges were: Ambulatory: $37 864 versus Elective laparoscopic: $54 377 versus Elective Open: $73 436 versus Non-elective Laparoscopic: $85 906, versus Non-elective Open: $117 845, and total annual healthcare charges were $4.28 billion. Conclusions: Incidence of HH repair and charges increased over the study period. The proportion of frail patients undergoing elective and non-elective repairs increased. Changes in the incidence of underlying disease, patient perceptions and symptom tolerance, or surgeon decision-making may have contributed to these trends.