Clinical Volume and Perioperative Outcomes of Hiatal Hernia Repair Within the Society of Thoracic Surgeons-General Thoracic Surgery Database

Background: This study investigates the relationship between clinical center operative volume and perioperative outcomes for elective hiatal hernia repairs. Methods: Patients receiving an elective hiatal hernia repair within the Society of Thoracic Surgeons-General Thoracic Surgery Database (2018–2023) were included. Patients with a cancer diagnosis or achalasia were excluded. Participant centers were categorized into low-, medium-, and high-volume tertiles based on annual elective hiatal hernia operative volume. Primary outcomes were 30-day morbidity and reoperation. Secondary outcomes included mortality and 30-day readmission. Multivariable regressions were performed to adjust for covariates, including sociodemographics, comorbidities, and hernia characteristics. Results: Among 174 centers, 13,658 elective hiatal hernia repairs were performed. A total of 295 (2.2%), 1714 (12.5%), and 11,649 (85.3%) repairs were performed at low-, medium-, and high-volume centers, respectively. Mortality within 30 days was <0.5% and did not differ by center volume. There was a stepwise decrease in 30-day morbidity (22.4% vs 18.4% vs 14.0%; P < 0.001), reoperation (4.7% vs. 2.7% vs 1.7%; P <0.001), and readmission (7.8% vs 7.3% vs. 5.8%; P < 0.001) when comparing low-, medium-, and high-volume centers. Minimally invasive approaches were more common at high-volume centers (94.4% vs 81.5% vs 82.1%; P < 0.001), and length of stay was shorter (2 days vs 3 days vs 3 days; P < 0.001). These differences remained significant for 30-day morbidity and 30-day reoperation in multivariable analysis. Conclusions: Perioperative outcomes after hiatal hernia repair were significantly improved when treatment occurred at high-volume centers. Referral to high-volume centers is encouraged for elective repairs.