Elevated early recurrence of paraesophageal hernias in chronic obstructive pulmonary disease patients: a comparative risk analysis

BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases surgical morbidity and mortality, but its effect on paraesophageal hernia repair (PEHR) is unknown. This study aimed to evaluate the associations between COPD and PEHR outcomes, hypothesizing an increased risk of hernia recurrence in patients with COPD. METHODS: A retrospective cohort study (2011-2022) was conducted on elective patients with PEHR, stratified into COPD and high-risk non-COPD groups (American Society of Anesthesiologists ASA class 3 or 4). The primary outcome was early recurrence (<6 months). Propensity score matching (1:1) was used to control for age, gender, and body mass index (BMI). The chi-squared and Mann-Whitney U tests were used to compare demographics and outcomes. Kaplan-Meier curves were used to analyze the recurrence timing, and multivariate logistic regression was used to assess COPD as an independent risk factor, adjusting for age, BMI, ASA class, and smoking status. RESULTS: Among 537 patients, 62 matched pairs were analyzed. COPD was not linked to increased respiratory complications but was associated with higher discharge to advanced care (12.9% vs 1.6%; P =.038) and earlier recurrence (160 vs 652 days; P =.01). Kaplan-Meier curves showed increased early recurrence in patients with COPD (P =.02), although recurrence rates converged later. COPD independently predicted early recurrence (odds ratio, 4.4; P <.001). CONCLUSION: COPD is an independent risk factor for early recurrence after PEHR, although it does not increase the risk of respiratory complications or overall recurrence. Patients with COPD more frequently required higher-level care and experienced earlier recurrence. Our findings may guide shared decision-making and suggest strategies to mitigate recurrence risk, such as routine mesh placement.