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Early outcomes of antireflux surgery for United States lung transplant recipients

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Abstract

Background

This study aimed to evaluate early outcomes after antireflux surgery for lung transplant (LTx) recipients in the United States.

Methods

Adult patients undergoing elective antireflux surgery between 2003 and 2008 were identified in the Nationwide Inpatient Sample. A propensity-matched analysis compared early outcomes between prior LTx recipients and well-matched control subjects consisting of non-LTx patients undergoing elective antireflux surgery during the same era. The primary outcome was inpatient mortality, and the secondary outcomes were hospital length of stay (LOS), perioperative complications, and hospital costs.

Results

During the study period, 401 LTx recipients underwent elective antireflux surgery. These patients were well matched with 401 control patients in terms of age, sex, individual and overall comorbidity burden, hospital teaching status, hospital location, hospital antireflux volume, and open versus laparoscopic approach. The overall operative mortality rate was 1.4 %, with no difference between the groups. The overall and individual morbidity rates also were similar. The LOS and hospital costs were significantly greater in the LTx group. Multivariable logistic regression analysis confirmed that prior LTx did not confer an increased risk of inpatient mortality after antireflux surgery.

Conclusions

To date, this is the largest study to examine outcomes of antireflux surgery for LTx recipients. Operative mortality and morbidity appear to be comparable with those of the general population, although resource utilization is greater. Based on these data, trials to evaluate the role of antireflux surgery in preserving allograft function after LTx should not be hindered by a perceived notion of prohibitive operative risk in this patient population.

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References

  1. Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dobbels F, Kirk R, Rahmel AO, Stehlik J, Hertz MI (2011) The registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult lung and heart–lung transplant report—2011. J Heart Lung Transplant 30:1104–1122

    Article  PubMed  Google Scholar 

  2. Heng D, Sharples LD, McNeil K, Stewart S, Wreghitt T, Wallwork J (1998) Bronchiolitis obliterans syndrome: incidence, natural history, prognosis, and risk factors. J Heart Lung Transplant 17:1255–1263

    PubMed  CAS  Google Scholar 

  3. Valentine VG, Robbins RC, Berry GJ, Patel HR, Reichenspurner H, Reitz BA, Theodore J (1996) Actuarial survival of heart–lung and bilateral sequential lung transplant recipients with obliterative bronchiolitis. J Heart Lung Transplant 15:371–383

    PubMed  CAS  Google Scholar 

  4. Davis RD Jr, Lau CL, Eubanks S, Messier RH, Hadjiliadis D, Steele MP, Palmer SM (2003) Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation. J Thorac Cardiovasc Surg 125:533–542

    Article  PubMed  Google Scholar 

  5. Overview of the Nationwide Inpatient Sample (2012). http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 17 July 2012

  6. Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17:864–867

    Article  PubMed  CAS  Google Scholar 

  7. Hadjiliadis D, Duane Davis R, Steele MP, Messier RH, Lau CL, Eubanks SS, Palmer SM (2003) Gastroesophageal reflux disease in lung transplant recipients. Clin Transplant 17:363–368

    Article  PubMed  Google Scholar 

  8. Button BM, Roberts S, Kotsimbos TC, Levvey BJ, Williams TJ, Bailey M, Snell GI, Wilson JW (2005) Gastroesophageal reflux (symptomatic and silent): a potentially significant problem in patients with cystic fibrosis before and after lung transplantation. J Heart Lung Transplant 24:1522–1529

    Article  PubMed  Google Scholar 

  9. Sweet MP, Patti MG, Leard LE, Golden JA, Hays SR, Hoopes C, Theodore PR (2007) Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. J Thorac Cardiovasc Surg 133:1078–1084

    Article  PubMed  Google Scholar 

  10. Kempainen RR, Savik K, Whelan TP, Dunitz JM, Herrington CS, Billings JL (2007) High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD. Chest 131:1666–1671

    Article  PubMed  Google Scholar 

  11. Berkowitz N, Schulman LL, McGregor C, Markowitz D (1995) Gastroparesis after lung transplantation: potential role in postoperative respiratory complications. Chest 108:1602–1607

    Article  PubMed  CAS  Google Scholar 

  12. Young LR, Hadjiliadis D, Davis RD, Palmer SM (2003) Lung transplantation exacerbates gastroesophageal reflux disease. Chest 124:1689–1693

    Article  PubMed  Google Scholar 

  13. Duarte AG, Terminella L, Smith JT, Myers AC, Campbell G, Lick S (2008) Restoration of cough reflex in lung transplant recipients. Chest 134:310–316

    Article  PubMed  Google Scholar 

  14. King BJ, Iyer H, Leidi AA, Carby MR (2009) Gastroesophageal reflux in bronchiolitis obliterans syndrome: a new perspective. J Heart Lung Transplant 28:870–875

    Article  PubMed  Google Scholar 

  15. Parada MT, Alba A, Sepulveda C (2010) Bronchiolitis obliterans syndrome development in lung transplantation patients. Transplant Proc 42:331–332

    Article  PubMed  CAS  Google Scholar 

  16. Hoppo T, Jarido V, Pennathur A, Morrell M, Crespo M, Shigemura N, Bermudez C, Hunter JG, Toyoda Y, Pilewski J, Luketich JD, Jobe BA (2011) Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg 146:1041–1047

    Article  PubMed  Google Scholar 

  17. Hartwig MG, Anderson DJ, Onaitis MW, Reddy S, Snyder LD, Lin SS, Davis RD (2011) Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux. Ann Thorac Surg 92:462–468

    Article  PubMed  Google Scholar 

  18. Murthy SC, Nowicki ER, Mason DP, Budev MM, Nunez AI, Thuita L, Chapman JT, McCurry KR, Pettersson GB, Blackstone EH (2011) Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation. J Thorac Cardiovasc Surg 142:47–52

    Article  PubMed  Google Scholar 

  19. Burton PR, Button B, Brown W, Lee M, Roberts S, Hassen S, Bailey M, Smith A, Snell G (2009) Medium-term outcome of fundoplication after lung transplantation. Dis Esophagus 22:642–648

    Article  PubMed  CAS  Google Scholar 

  20. Brehant O, Pessaux P, Arnaud JP, Delattre JF, Meyer C, Baulieux J, Mosnier H (2006) Long-term outcome of laparoscopic antireflux surgery in the elderly. J Gastrointest Surg 10:439–444

    Article  PubMed  Google Scholar 

  21. Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB (2004) Evidence-based appraisal of antireflux fundoplication. Ann Surg 239:325–337

    Article  PubMed  Google Scholar 

  22. Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, Arndorfer J, Christensen L, Merion RM (2003) Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 349:931–940

    Article  PubMed  CAS  Google Scholar 

  23. Fisichella PM, Davis CS, Gagermeier J, Dilling D, Alex CG, Dorfmeister JA, Kovacs EJ, Love RB, Gamelli RL (2011) Laparoscopic antireflux surgery for gastroesophageal reflux disease after lung transplantation. J Surg Res 170:e279–e286

    Article  PubMed  Google Scholar 

  24. Klabunde CN, Warren JL, Legler JM (2002) Assessing comorbidity using claims data: an overview. Med Care 40:26–35

    Article  Google Scholar 

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Acknowledgments

This study was supported by departmental funds from the Department of Surgery at the Johns Hopkins Medical Institutions.

Disclosures

Arman Kilic, Ashish S. Shah, Christian A. Merlo, Christine G. Gourin, and Anne O. Lidor have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins Medical Institutions, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Arman Kilic, Ashish S. Shah & Anne O. Lidor

  2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Christian A. Merlo

  3. Department of Otolaryngology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Christine G. Gourin

Authors
  1. Arman Kilic
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  2. Ashish S. Shah
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  3. Christian A. Merlo
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  4. Christine G. Gourin
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  5. Anne O. Lidor
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Corresponding author

Correspondence to Arman Kilic.

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Kilic, A., Shah, A.S., Merlo, C.A. et al. Early outcomes of antireflux surgery for United States lung transplant recipients. Surg Endosc 27, 1754–1760 (2013). https://doi.org/10.1007/s00464-012-2674-9

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  • DOI: https://doi.org/10.1007/s00464-012-2674-9

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