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Antireflux Surgery in the USA: Influence of Surgical Volume on Perioperative Outcomes and Costs—Time for Centralization?

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Abstract

Background

Few studies have analyzed the relationship between surgical volume and outcomes after antireflux procedures. The aim of this study was to determine the effect of surgical volume on postoperative results and costs for patients undergoing surgery for gastroesophageal reflux disease.

Methods

We analyzed the National Inpatient Sample (period 2000–2013). Adult patients (≥18 years old) with gastroesophageal reflux disease who underwent fundoplication were included. Hospital surgical volume was determined using the 30th and 60th percentile cut points using weighted discharges and categorized as low (<10 operations/year), intermediate (10–25 operations/year), or high (>25 operations/year). We performed multivariable logistic regression models to assess the effect of surgical volume on patient outcomes.

Results

The studied cohort comprised 75,544 patients who had antireflux surgery. When operations performed at low-volume hospitals, postoperative bleeding, cardiac failure, renal failure, respiratory failure, and inpatient mortality were more common. In intermediate-volume hospitals, patients were more likely to have postoperative infection, esophageal perforation, bleeding, cardiac failure, renal failure, and respiratory failure. The length of hospital stay was longer at low- and intermediate-volume hospitals (1.08 and 0.55 days longer, respectively). There was an increase in charges of 5120 dollars per patient at low-volume centers, and 4010 dollars per patient at intermediate-volume centers.

Conclusions

When antireflux surgery is performed at high-volume hospitals, morbidity is lower, length of hospital stay is shorter, and costs for the healthcare system are decreased.

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References

  1. El-Serag HN, Sweet S, Winchester CC et al (2014) Update on the epidemiology of gastro-esophageal reflux disease: a systematic review. Gut 63(6):871–880

    Article  PubMed  Google Scholar 

  2. Dallemagne B, Weerts J, Markiewicz S et al (2006) Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 20(1):159–165

    Article  PubMed  CAS  Google Scholar 

  3. Broeders JA, Rijnhart-de Jong HG, Draaisma WA et al (2009) Ten-year outcome of laparoscopic and conventional Nissen fundoplication: randomized clinical trial. Ann Surg 250(5):698–706

    Article  PubMed  Google Scholar 

  4. Morgenthal CB, Shane MD, Stival A et al (2007) The durability of laparoscopic Nissen fundoplication: 11-year outcomes. J Gastrointest Surg 11(6):693–700

    Article  PubMed  Google Scholar 

  5. Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137

    Article  PubMed  Google Scholar 

  6. Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364(22):2128–2137

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Alsfasser G, Leicht H, Günster C et al (2016) Volume-outcome relationship in pancreatic surgery. Br J Surg 103(1):136–143

    Article  PubMed  CAS  Google Scholar 

  8. Munasinghe A, Markar SR, Mamidanna R et al (2015) Is it time to centralize high-risk cancer care in the United States? Comparison of outcomes of esophagectomy between England and the United States. Ann Surg 262(1):79–85

    Article  PubMed  Google Scholar 

  9. Markar SR, Karthikesalingam A, Thrumurthy S et al (2012) Volume-outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000–2011. J Gastrointest Surg 16(5):1055–1063

    Article  PubMed  Google Scholar 

  10. Finks JF, Wei Y, Birkmeyer JD (2006) The rise and fall of antireflux surgery in the United States. Surg Endosc 20(11):1698–1701

    Article  PubMed  Google Scholar 

  11. Wang YR, Dempsey DT, Richter JE (2011) Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Dis Esophagus 24(4):215–223

    Article  PubMed  CAS  Google Scholar 

  12. Henneman D, Dikken JL, Putter H et al (2014) Centralization of esophagectomy: how far should we go? Ann Surg Oncol 21(13):4068–4074

    Article  PubMed  Google Scholar 

  13. Pal N, Axisa B, Yusof S et al (2008) Volume and outcome for major upper GI surgery in England. J Gastrointest Surg 12(2):353–357

    Article  PubMed  CAS  Google Scholar 

  14. O’Mahoney PR, Yeo HL, Sedrakyan A et al (2016) Centralization of pancreatoduodenectomy a decade later: impact of the volume-outcome relationship. Surgery 159(6):1528–1538

    Article  PubMed  Google Scholar 

  15. Wang YR, Dempsey DT, Friedenberg FK et al (2008) Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993–2005: effect of surgery volume on perioperative outcomes. Am J Gastroenterol 103(10):2454–2464

    Article  PubMed  Google Scholar 

  16. Colavita PD, Belyansky I, Walters AL et al (2013) Nationwide inpatient sample: have antireflux procedures undergone regionalization? J Gastrointest Surg 17(1):6–13

    Article  PubMed  Google Scholar 

  17. Varban OA, McCoy TP, Westcott C (2011) A comparison of pre-operative comorbidities and post-operative outcomes among patients undergoing laparoscopic nissen fundoplication at high- and low-volume centers. J Gastrointest Surg 15(7):1121–1127

    Article  PubMed  Google Scholar 

  18. Dallemagne B, Weerts JM, Jehaes C et al (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1(3):138–143

    PubMed  CAS  Google Scholar 

  19. Schlussel AT, Delaney CP, Maykel JA et al (2016) A national database analysis comparing the nationwide inpatient sample and American College of Surgeons National Surgical Quality Improvement Program in laparoscopic vs open colectomies: inherent variance may impact outcomes. Dis Colon Rectum 59(9):843–854

    Article  PubMed  Google Scholar 

  20. Qu H, Liu Y, He QS (2014) Short- and long-term results of laparoscopic versus open anti-reflux surgery: a systematic review and meta-analysis of randomized controlled trials. J Gastrointest Surg 18(6):1077–1086

    Article  PubMed  Google Scholar 

  21. Schlottmann F, Strassle PD, Patti MG (2017) Comparative analysis of perioperative outcomes and costs between laparoscopic and open antireflux surgery. J Am Coll Surg 224(3):327–333

    Article  PubMed  Google Scholar 

  22. Khan F, Maradey-Romero C, Ganocy S et al (2016) Utilisation of surgical fundoplication for patients with gastro-oesophageal reflux disease in the USA has declined rapidly between 2009 and 2013. Aliment Pharmacol Ther 43(11):1124–1131

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA

    Francisco Schlottmann & Paula D. Strassle

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

    Paula D. Strassle

  3. Department of Medicine and Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Marco G. Patti

Authors
  1. Francisco Schlottmann
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  2. Paula D. Strassle
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  3. Marco G. Patti
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Corresponding author

Correspondence to Francisco Schlottmann.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Oral presentation nominated for Grassi Prize during 47th World Congress of Surgery, Basel, Switzerland, August 13–17, 2017.

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Schlottmann, F., Strassle, P.D. & Patti, M.G. Antireflux Surgery in the USA: Influence of Surgical Volume on Perioperative Outcomes and Costs—Time for Centralization?. World J Surg 42, 2183–2189 (2018). https://doi.org/10.1007/s00268-017-4429-1

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  • DOI: https://doi.org/10.1007/s00268-017-4429-1

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