Early outcomes of antireflux surgery for United States lung transplant recipients
- 188 Downloads
This study aimed to evaluate early outcomes after antireflux surgery for lung transplant (LTx) recipients in the United States.
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.
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.
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.
KeywordsComplications Costs Esophageal GERD Pulmonary (lungs) Transplantation
This study was supported by departmental funds from the Department of Surgery at the Johns Hopkins Medical Institutions.
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.
- 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 30:1104–1122PubMedCrossRefGoogle Scholar
- 5.Overview of the Nationwide Inpatient Sample (2012). http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 17 July 2012
- 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 24:1522–1529PubMedCrossRefGoogle 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 146:1041–1047PubMedCrossRefGoogle Scholar