Paraesophageal hernia repair is associated with similar safety and efficacy results in octogenarians as compared to younger patients

Background National database studies suggest elective paraesophageal hernia (PEH) repair in octogenarians is safe but provide limited detail on operative strategy and long-term symptom outcomes. We evaluated perioperative outcomes, operative strategy, and post-discharge functional outcomes in octogenarians undergoing PEH repair compared with younger patients in a contemporary institutional cohort. Methods A retrospective review of 2,517 PEH repairs performed at a tertiary academic center from 2010–2023 was conducted. Patients were stratified by age (18–79 vs. ≥ 80 years). Demographics, operative characteristics, 30-day complications, recurrence, reoperation, and postoperative symptoms were compared. Multivariable logistic regression identified predictors of composite adverse outcome (CAO), defined as postoperative GERD, dysphagia, recurrence, or reoperation. Results Of 2,517 patients, 195 (7.7%) were ≥ 80 years. Compared with younger patients, octogenarians had lower BMI (26.9 vs. 32.5 kg/m 2 , p < 0.001), higher rates of cardiovascular disease (83.6% vs. 61.0%, p < 0.001), and more frequent ASA ≥ III (93.2% vs. 69.6% p < 0.001). Non-elective surgery was more common in octogenarians (30.6% vs. 6.0%, p < 0.001). Surgeons performed gastropexy more than twice as often in octogenarians (43.6% vs. 17.3%, p < 0.001) and used mesh reinforcement at higher rates (21.5% vs. 13.0%, p = 0.004), while fundoplication rates were similar (33.3% vs. 38.7%, p = 0.12). Thirty-day complications were higher in octogenarians (15.9% vs. 9.1%, p = 0.006), with no significant difference in mortality (1.0% vs. 0.3%, p = 0.15). Hernia recurrence, postoperative GERD, dysphagia, and reoperation were similar between groups ( p > 0.05 for all). Age ≥ 80 was not independently associated with CAO (OR 1.05, 95% CI 0.72–1.54, p = 0.79). Conclusions PEH repair in octogenarians is associated with increased perioperative morbidity but similar PEH-related outcomes compared with younger patients. These findings support consideration of elective repair in appropriately selected symptomatic octogenarians and individualized risk assessment based on comorbidities rather than age alone.