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Introduction Giant Paraesophageal hiatal hernias (PEH) are most commonly associated with symptoms of chest pain, early satiety and GERD. However, Iron-deficiency anaemia is an under-appreciated condition associated with giant PEH. The aim of this study was to evaluate the incidence of iron-deficiency anaemia in a cohort of patients with giant PEH and assess the incidence of resolution associated with operative PEH repair. Methods Between 2000 and 2010, 270 patients underwent operative repair of PEH and were prospectively entered into an IRB-approved database. From this cohort, 123 (45.6%) patients demonstrated a pre-existing diagnosis of iron-deficiency anaemia. 77 patients had a documented pre-operative haemoglobin level (Hb) consistent with iron-deficiency anaemia and a follow-up Hb level at least 3 months following surgery and constituted the study population. Results From the cohort of 77 patients with documented pre-operative iron-deficiency anaemia, 72 (94%) underwent elective PEH repair, with a median age was 75 (range 39–91). Cameron erosions were endoscopically documented preoperatively in 25 patients (32%). The average preoperative Hb value was 11.8 (7.6–16). Postoperatively at 3–12 month follow-up, the average Hb level was 13.2 (10.7–17), and at more than 1 year follow-up it was 13.6 (9.2–17.2) (p Conclusion This single institution study shows a high incidence of iron-deficiency anaemia (45.6%) in patients with giant PEH. Elective repair results in resolution of the anaemia and discontinuation of iron supplementation therapy, in more than 70% of patients. This improvement in Hb is independent of the presence of pre-operative Cameron erosions. This study demonstrates the clinical and potential economic benefits of elective PEH repair of patients with Giant PEH and iron-deficiency anaemia. Competing interests None declared.

Introduction Delirium is an under-estimated and serious complication following major surgery, particularly in the elderly population. The aim of this study was to identify pre-operative risk factors for delirium following oesophagectomy for malignancy, and investigate its impact upon short and long-term outcome. Methods All patients undergoing oesophagectomy for cancer between 1991 and 2011 had information prospectively entered in an IRB-approved database. Patients were divided into two groups based upon the presence or absence of clinically-significant post-operative delirium, and were compared with respect to use of neoadjuvant therapy, medical co-morbidities, operative outcomes, post-operative complications, overall cost and survival. For the purposes of this study delirium was defined as an acute fluctuating confusional state that required intervention. Results 500 patients were included in this analysis; 46 (9.2%) patients with post-operative delirium and 454 patients without. In the delirium group, age was significantly increased (71±8.1 yrs vs 63±10.9 yrs) and BMI was reduced (25±4.2 vs 27±4.8 kg/m 2 ). There were no significant differences in cardiac, pulmonary or renal co-morbidities, however ASA grade (2.8±0.4 vs 2.6±0.5) and Charlson Co-morbidity index (2.5±0.7 vs 2.3±0.6) were significantly increased in the delirium group. There were no significant differences between the groups in the use of neoadjuvant therapy. Analysis demonstrated that delirium was associated with a significantly longer hospital (14±7.5 vs 10.9±5.7 days) and ICU stay (3.6±3.8 vs 2.7±16.9 days). Furthermore post-operative delirium was associated with a significantly increased incidence of post-operative pneumonia (21.7% vs 7.9%), pneumothorax (10.9% vs 2.6%), re-intubation (10.9% vs 1.8%) and increased overall treatment costs ($28 223±13 018 vs $22 702±9689; p Conclusion This study demonstrates that delirium is a risk factor for complicated post-operative recovery and increased treatment costs following oesophagectomy, and furthermore that age is independently predictive of its development. Focused screening will allow targeted preventative strategies to be employed in the peri-operative period to reduce complications and cost associated with delirium. Competing interests None declared.