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Surgery for benign esophageal disorders in the US: risk factors for complications and trends of morbidity

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Abstract

Background

Gastroesophageal reflux disease (GERD), paraesophageal hernia (PEH), and achalasia are the most frequent benign esophageal disorders that may need surgical treatment. We aimed to identify risk factors for postoperative complications and to characterize trends of morbidity for surgery for benign esophageal disorders in a national cohort.

Methods

A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000–2013. Adult patients (≥ 18 years old) diagnosed with GERD, PEH, and achalasia, and who underwent fundoplication, PEH repair, and esophagomyotomy were included. The yearly incidence of complications, stratified by procedure, was calculated using Poisson regression, and multivariable logistic regression was used to determine risk factors for complications.

Results

A total of 79,622 patients were included; 38,695 (48.6%) underwent PEH repair, 38,719 (48.6%) fundoplication, and 2208 (2.8%) esophagomyotomy. While the rate of postoperative complications dropped from 26.5 to 10.0% and from 16.1 to 12.2% for PEH repair and esophagomyotomy, respectively, the complication rate after fundoplication increased from 5.7 to 12.7% during the same period (p < 0.0001). Age, black race, diabetes, renal insufficiency, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, and open surgery were independent risk factors for postoperative complications. The rate of laparoscopic procedures for PEH repair increased from 4.9 to 91.4%, while for fundoplication it increased from 24.2 to 78.3% (p < 0.0001).

Conclusions

Opposite to PEH repair and esophagomyotomy, antireflux surgery has shown an increase in the morbidity rate in the last decade. Patient selection and embracement of laparoscopic techniques are critical to improve the perioperative outcome in surgery for benign esophageal disorders.

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Authors and Affiliations

  1. Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA

    Francisco Schlottmann & Marco G. Patti

  2. Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina

    Francisco Schlottmann

  3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Paula D. Strassle

  4. Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Marco G. Patti

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  1. Francisco Schlottmann
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  2. Paula D. Strassle
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  3. Marco G. Patti
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Correspondence to Francisco Schlottmann.

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Disclosures

Francisco Schlottmann, Paula Strassle, and Marco Patti have no conflict of interest or financial ties to disclose.

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Schlottmann, F., Strassle, P.D. & Patti, M.G. Surgery for benign esophageal disorders in the US: risk factors for complications and trends of morbidity. Surg Endosc 32, 3675–3682 (2018). https://doi.org/10.1007/s00464-018-6102-7

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  • DOI: https://doi.org/10.1007/s00464-018-6102-7

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