S. K. Rancy1, V. G. Bangla1, C. M. Divino1 1Mount Sinai School Of Medicine, Department Of Surgery, New York, NY, USA
Introduction: Hiatal hernia (HH) affects 10-50% of the US adult population. Symptoms such as dysphagia, oral intolerance, retching, early satiety, postprandial bloating, and epigastric pain are suggestive of mechanical obstruction. However, the prevalence and factors predictive of obstruction have not been quantified.
Methods: This was a cross-sectional study of data from the 2016-2018 National Inpatient Sample. The database was queried using ICD-10 codes K44.0, K44.1, and K44.9 to identify patients with HH with obstruction but without gangrene, with gangrene, and without obstruction or gangrene, respectively. Demographic data on age, sex, race, insurance status, income, hospital bed size, hospital type, and hospital region were collected as co-variables to identify predictors of obstruction. Univariate analysis was conducted using the Rao-Scott Chi-square for categorical and two-tailed student’s t-test for continuous variables. Multivariate logistic regression modeled factors associated with obstruction. Survey procedures accounting for weight, clusters, and strata were used to create national estimates.
Results: Of 89,630 patients with HHs, 19,670 were obstructed and/or gangrenous (21.9%). On univariate analysis, compared to non-obstructed patients, obstructed patients were significantly younger (63.9 vs. 70 years, P <0.0001) and had a greater proportion of male sex (31.6% vs 25%, P <0.0001), white ethnicity (84.4% vs. 81.7%, P <0.003), and self-pay and government-based insurance (75.1% vs. 65.8%, P <0.0001). On multivariable adjusted analysis, risk of HH obstruction was significantly associated with age (OR 1.03 [1.03-1.03], P <0.0001), male sex (OR 1.56 [1.44-1.69], P <0.0001), and self-pay insurance status (2.47 [1.81-3.38], P <0.0001).
Conclusion: Of hospitalized patients with hiatal hernias, 21.9% are symptomatically obstructed. Age, male sex, and self-pay insurance status are significant demographic predictors of obstruction.
