Increasing rate of para‐oesophageal hiatus hernia surgical repair within Australia

Operations claimed under MBS item number 31468 (para‐oesophageal hiatus hernia, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication) have significantly increased in Australia since January 2001. Reasons for this rise are likely multifactorial, and may indicate: increasing para‐oesophageal hiatus hernia incidence; increased diagnosis and investigation; or increased surgical capability to manage the issue laparoscopically with reduced peri‐operative morbidity.

Background

Symptomatic para‐oesophageal hiatus (PEH) hernias are treated by surgical intervention, and are associated with older age (>50 years) and higher body mass index (>25 kg/m²). Both risk factors are increasing within the Australian population. Given these trends, this study aimed to determine if the rate of PEH repair is increasing within Australia.

Methods

The study used publically available Medicare Benefits Scheme service data for operations claimed under the item number 31468 (PEH hernia, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication) between 1 January 2001 and 31 December 2016. Directly age‐standardized rates per 100 000 population were calculated using the 2001 Australian standard population and compared using Poisson regression models.

Results

Repair of PEH significantly increased (P < 0.0001) in Australia during this period, with the average number of services increasing by 14.6% per annum. Average rates of repair increased significantly (P < 0.001) with increasing age up to 75 years after which they significantly reduced (P < 0.001) in each successive age group. Western Australia had the greatest increase in annual claims and Northern Territory had the least, but the state‐specific average claim rate over the whole period was highest in Queensland and lowest in Northern Territory.

Conclusion

Operations claimed under Medicare Benefits Scheme item number 31468 have significantly increased in Australia since January 2001. Reasons for this rise are likely multifactorial, and may indicate increasing PEH incidence, increased diagnosis and investigation or increased surgical capability to manage the issue laparoscopically with reduced peri‐operative morbidity.

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