Abstract
Background
National rates of laparoscopic antireflux surgery grew steadily in the 1990s. Since then, a highly visible randomized trial has questioned the long-term effectiveness of antireflux surgery, several new endoscopic therapies have been developed, and proton pump inhibitors have become available over the counter. Whether these recent developments have had an impact on the use of antireflux surgery remains unknown.
Methods
Using data from the Nationwide Inpatient Sample, this study identified all patients older than 18 years who underwent antireflux surgery between 1994 and 2003. Sampling weights were used to estimate the total number of procedures performed in the United States each year. Population-based rates were determined using denominators from U.S. census data.
Results
Confirming the results of earlier studies, this study found that the annual number of antireflux procedures grew rapidly during the 1990s, peaking at 31,695 (15.7 cases per 100,000 adults) in 1999. After 1999, surgical rates declined steadily, falling approximately 30% by 2003 to 23,998 (11 cases per 100,000; p < 0.0001). Use of antireflux procedures fell more precipitously among younger patients (39% for 30- to 49-year-olds vs 12.5% for those older than 60 years; p < 0.0001) and at teaching hospitals (36% vs 23% at nonteaching hospitals; p < 0.0001). The proportion of cases managed laparoscopically remained stable after 1999.
Conclusions
The use of antireflux surgery in the United States has declined substantially. Although other factors may be involved, this trend may reflect new questions about the long-term effectiveness of surgery and suggests the need for prospective randomized clinical trials assessing current therapies.
Similar content being viewed by others
References
DeVault KR, Castell DO (2005) Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 100: 190–200
Ferreira MR, Bennett RL, Gilman SC, Mathewson S, Bennett CL (1999) Diffusion of laparoscopic cholecystectomy in the Veterans Affairs health care system, 1991–1995. Eff Clin Pract 2: 49–55
Finlayson SR, Birkmeyer JD, Laycock WS (2003) Trends in surgery for gastroesophageal reflux disease: the effect of laparoscopic surgery on utilization. Surgery 133: 147–153
Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17: 864–867
Finley CR, McKernan JB (2001) Laparoscopic antireflux surgery at an outpatient surgery center. Surg Endosc 15: 823–826
HCUP (2003) Nationwide Inpatient Sample (NIS). Agency for Healthcare Research and Quality
Kahrilas PJ (1999) Laparoscopic antireflux surgery: silver bullet or the emperor’s new clothes? Am J Gastroenterol 94: 1721–1723
Klaus A, Hinder RA, DeVault KR, Achem SR (2003) Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course. Am J Med 114: 6–9
Metz DC (2004) Managing gastroesophageal reflux disease for the lifetime of the patient: evaluating the long-term options. Am J Med 117(Suppl 5A): 49S–55S
Nenner RP, Imperato PJ, Rosenberg C, Ronberg E (1994) Increased cholecystectomy rates among Medicare patients after the introduction of laparoscopic cholecystectomy. J Community Health 19: 409–415
Patterson EJ, Davis DG, Khajanchee Y, Swanstrom LL (2003) Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc 17: 1561–1565
Perry Y, Courcoulas AP, Fernando HC, Buenaventura PO, McCaughan JS, Luketich JD (2004) Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS 8: 19–23
Ray S (2003) Result of 310 consecutive patients undergoing laparoscopic Nissen fundoplication as hospital outpatients or at a freestanding surgery center. Surg Endosc 17: 378–380
Rothstein RI, Dukowicz AC (2005) Endoscopic therapy for gastroesophageal reflux disease. Surg Clin North Am 85: 949–965
Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122: 1500–1511
Spechler SJ (1992) Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. N Engl J Med 326: 786–792
Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufman JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W (2001) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 285: 2331–2338
Trus TL, Pope GD, Finlayson SR (2005) National trends in utilization and outcomes of bariatric surgery. Surg Endosc 19: 616–620
Urbach DR, Stukel TA (2005) Rate of elective cholecystectomy and the incidence of severe gallstone disease. CMAJ 172: 1015–1019
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Finks, J.F., Wei, Y. & Birkmeyer, J.D. The rise and fall of antireflux surgery in the United States. Surg Endosc 20, 1698–1701 (2006). https://doi.org/10.1007/s00464-006-0042-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-006-0042-3