Outcomes of emergent hiatal hernia repair: does specialty matter?

Abstract Background Hiatal hernia repair is a common procedure performed by both general and thoracic surgeons. While prior studies have shown that emergent hiatal hernia repairs are associated with worse outcomes than elective cases, differences in outcomes by surgical specialty for emergent repairs have not been well-described. Methods The American College of Surgeons–National Surgical Quality Improvement Program (ACS–NSQIP) database was queried for patients undergoing hiatal hernia repair from 2012 to 2024. Patients undergoing elective repair and non-primary repairs were excluded. Perioperative outcomes were compared between patients with procedures performed by general and thoracic surgeons. Multivariable logistic regression was used to evaluate differences in outcomes after adjustment for demographics, comorbidities, and preoperative risk factors. Results A total of 2,629 patients were identified, including 2,443 (92.9%) performed by general surgery and 186 (7.1%) performed by thoracic surgery. The majority of cases were performed laparoscopically (74.9%) with no mesh placement (70%). On unadjusted analysis, perioperative outcomes were similar between groups. After multivariable adjustment, surgical specialty was not independently associated with 30-day mortality (OR 0.67, 95% CI 0.26–1.73), readmission (OR 0.81, 95% CI 0.45–1.44), reoperation (OR 1.64, 95% CI 0.89–3.04), overall morbidity (OR 1.16, 95% CI 0.79–1.70), and length of stay (β = 0.15 days, 95% CI –1.05 to 1.36). Conclusions Among patients undergoing emergent hiatal hernia repair, there were no significant differences in short-term outcomes between general and thoracic surgeons after multivariable adjustment.