Conflict of interest: none.
Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006
Article first published online: 12 NOV 2010
© 2010 Copyright the Authors. Journal compilation © 2010, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus
Diseases of the Esophagus
Volume 24, Issue 4, pages 215–223, May 2011
How to Cite
Wang, Y. R., Dempsey, D. T. and Richter, J. E. (2011), Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Diseases of the Esophagus, 24: 215–223. doi: 10.1111/j.1442-2050.2010.01123.x
Guarantor of the article: Y. Richard Wang
Specific author contributions
Conception and design: Y. Richard Wang, Daniel T. Dempsey, Joel E. Richter
Acquisition of data: Y. Richard Wang
Data analysis: Y. Richard Wang
Interpretation of results: Y. Richard Wang, Daniel T. Dempsey, Joel E. Richter
Drafting of manuscript: Y. Richard Wang
Critical revision of manuscript: Y. Richard Wang, Daniel T. Dempsey, Joel E. Richter.
Financial support: none.
- Issue published online: 20 MAY 2011
- Article first published online: 12 NOV 2010
- gastric bypass;
- gastroesophageal reflux disease;
- outcomes assessment;
Antireflux surgery is an effective treatment for gastroesophageal reflux disease, but postoperation complications and durability may be problematic. The objective of the study was to determine whether inpatient antireflux surgery continued to decline in the United States due to concerns about its long-term effectiveness and the popularity of gastric bypass surgery and to assess recent changes in its perioperative outcomes. Using the Nationwide Inpatient Sample, we identified adult patients undergoing inpatient antireflux surgery during 1993–2006 and compared the trends of inpatient antireflux surgery with inpatient gastric bypass surgery. Perioperative complications included laceration, splenectomy, transfusion, esophageal dilation, total parenteral nutrition, and infection. Inpatient antireflux surgery increased from 9173 in 1993 to 32 980 in 2000 (+260%) but then decreased to 19 668 in 2006 (−40%). Compared with 2000, patients undergoing inpatient antireflux surgery in 2006 were older (49.9 ± 32.4 vs. 54.6 ± 33.6 years) and had a longer length of stay (3.1 ± 10.0 vs. 3.7 ± 13.4 days), more complications (4.7% vs. 6.1%), and higher mortality (0.26% vs. 0.54%) (all P < 0.05). Compared with inpatient gastric bypass surgery, length of stay was longer and mortality was higher for inpatient antireflux surgery in 2006, but neither was significant controlling for age. In 2006, perioperative outcomes of inpatient antireflux surgery were better in high-volume hospitals (all P < 0.01). Inpatient antireflux surgery continued to decline in the United States from 2000 to 2006, concomitant with a dramatic increase in inpatient gastric bypass surgery. Older patient age and worsening perioperative outcomes for inpatient antireflux surgery suggest increased medical complexity and possibly a larger share of reoperations over time. Designating centers of excellence for antireflux surgery based on local expertise may improve outcomes.