Elective antireflux surgery in the US

An analysis of national trends in utilization and inpatient outcomes from 2005 to 2010

Luke M. Funk, Aliyah Kanji, W. Scott Melvin, Kyle A. Perry

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Previous research suggested that antireflux surgery reached its peak volume in the US more than a decade ago. Factors such as changes in population demographics and improvements in surgical outcomes may have reversed this decline. We sought to examine national trends in the management of antireflux surgery patients and identify patient and hospital characteristics associated with postoperative complications. Methods: We analyzed data from the Nationwide Inpatient Sample to identify adults with gastroesophageal reflux disease or esophagitis who underwent elective antireflux surgery between 2005 and 2010. Patient and hospital characteristics were analyzed. A multivariate logistic regression model was used to identify characteristics associated with an increased risk of postoperative complications following laparoscopic antireflux surgery. Results: The volume of elective antireflux surgery remained relatively stable between 2005 (n = 15,819) and 2010 (n = 18,780). The percentage of patients older than 64 years of age increased from 21.1 % in 2005 to 30.9 % in 2010 (p < 0.01), while the percentage with a Charlson score over 2 more than doubled (1.2-2.7 %; p < 0.01). Inpatient complication rates (6.3 vs. 6.6 %; p = 0.21) and mortality (0.08 vs. 0.21; p = 0.72) were unchanged. On multivariate analysis, patients older than 79 years were three times as likely to develop a complication (odds ratio [OR] 3.1; 95 % CI 2.1-4.5) as were patients with a Charlson score over 2 (OR 3.1; 95 % CI 2.2-4.3). Conclusions: Today's antireflux surgery patient population is a higher-risk cohort, but complication rates have remained stable and inpatient mortality has declined more than 50 % over the past decade. Given these findings, additional research is needed to understand why antireflux surgery is underutilized, with a decline of more than two-thirds since its peak in 1999.

Original languageEnglish (US)
Pages (from-to)1712-1719
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume28
Issue number5
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Inpatients
Logistic Models
Odds Ratio
Esophagitis
Mortality
Gastroesophageal Reflux
Research
Laparoscopy
Population
Multivariate Analysis
Demography

Keywords

  • Gastroesophageal reflux disease
  • Laparoscopic antireflux surgery
  • Minimally invasive surgery

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Elective antireflux surgery in the US : An analysis of national trends in utilization and inpatient outcomes from 2005 to 2010. / Funk, Luke M.; Kanji, Aliyah; Melvin, W. Scott; Perry, Kyle A.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 28, No. 5, 2014, p. 1712-1719.

Research output: Contribution to journalArticle

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abstract = "Background: Previous research suggested that antireflux surgery reached its peak volume in the US more than a decade ago. Factors such as changes in population demographics and improvements in surgical outcomes may have reversed this decline. We sought to examine national trends in the management of antireflux surgery patients and identify patient and hospital characteristics associated with postoperative complications. Methods: We analyzed data from the Nationwide Inpatient Sample to identify adults with gastroesophageal reflux disease or esophagitis who underwent elective antireflux surgery between 2005 and 2010. Patient and hospital characteristics were analyzed. A multivariate logistic regression model was used to identify characteristics associated with an increased risk of postoperative complications following laparoscopic antireflux surgery. Results: The volume of elective antireflux surgery remained relatively stable between 2005 (n = 15,819) and 2010 (n = 18,780). The percentage of patients older than 64 years of age increased from 21.1 {\%} in 2005 to 30.9 {\%} in 2010 (p < 0.01), while the percentage with a Charlson score over 2 more than doubled (1.2-2.7 {\%}; p < 0.01). Inpatient complication rates (6.3 vs. 6.6 {\%}; p = 0.21) and mortality (0.08 vs. 0.21; p = 0.72) were unchanged. On multivariate analysis, patients older than 79 years were three times as likely to develop a complication (odds ratio [OR] 3.1; 95 {\%} CI 2.1-4.5) as were patients with a Charlson score over 2 (OR 3.1; 95 {\%} CI 2.2-4.3). Conclusions: Today's antireflux surgery patient population is a higher-risk cohort, but complication rates have remained stable and inpatient mortality has declined more than 50 {\%} over the past decade. Given these findings, additional research is needed to understand why antireflux surgery is underutilized, with a decline of more than two-thirds since its peak in 1999.",
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N2 - Background: Previous research suggested that antireflux surgery reached its peak volume in the US more than a decade ago. Factors such as changes in population demographics and improvements in surgical outcomes may have reversed this decline. We sought to examine national trends in the management of antireflux surgery patients and identify patient and hospital characteristics associated with postoperative complications. Methods: We analyzed data from the Nationwide Inpatient Sample to identify adults with gastroesophageal reflux disease or esophagitis who underwent elective antireflux surgery between 2005 and 2010. Patient and hospital characteristics were analyzed. A multivariate logistic regression model was used to identify characteristics associated with an increased risk of postoperative complications following laparoscopic antireflux surgery. Results: The volume of elective antireflux surgery remained relatively stable between 2005 (n = 15,819) and 2010 (n = 18,780). The percentage of patients older than 64 years of age increased from 21.1 % in 2005 to 30.9 % in 2010 (p < 0.01), while the percentage with a Charlson score over 2 more than doubled (1.2-2.7 %; p < 0.01). Inpatient complication rates (6.3 vs. 6.6 %; p = 0.21) and mortality (0.08 vs. 0.21; p = 0.72) were unchanged. On multivariate analysis, patients older than 79 years were three times as likely to develop a complication (odds ratio [OR] 3.1; 95 % CI 2.1-4.5) as were patients with a Charlson score over 2 (OR 3.1; 95 % CI 2.2-4.3). Conclusions: Today's antireflux surgery patient population is a higher-risk cohort, but complication rates have remained stable and inpatient mortality has declined more than 50 % over the past decade. Given these findings, additional research is needed to understand why antireflux surgery is underutilized, with a decline of more than two-thirds since its peak in 1999.

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