Elective repairs of paraesophageal hernias lead to significantly better outcomes than urgent or emergent procedures.

• Elective surgeries had a textbook outcome rate of 88.1%, compared to 58.2% for urgent and 46.7% for emergent (p < 0.001).
• Elective repairs used laparoscopic or robotic techniques 96.3% of the time, versus only 40% for emergent cases (p < 0.001).

Surgeons should prioritize elective repairs when feasible to minimize complications and improve patient recovery.

• Patients undergoing emergent repairs had a 6.7% mortality rate and longer hospital stays (median 3 to 13 days).