Mortality, Reoperation, and Hospital Stay Within 90 Days of Primary and Secondary Antireflux Surgery in a Population-Based Multinational Study

Manar Yanes,Giola Santoni,John Maret-Ouda,Sheraz Markar,Eivind Ness-Jensen,Joonas Kauppila,Martti Färkkilä,Elsebeth Lynge,Eero Pukkala,Laufey Tryggvadóttir,My Von Euler-Chelpin,Jesper Lagergren

doi:10.1053/j.gastro.2021.02.022

Abstract

Absolute rates and risk factors of short-term outcomes after antireflux surgery remain largely unknown. We aimed to clarify absolute risks and risk factors for poor 90-day outcomes of primary laparoscopic and secondary antireflux surgery. This population-based cohort study included patients who had primary laparoscopic or secondary antireflux surgery in the 5 Nordic countries in 2000-2018. In addition to absolute rates, we analyzed age, sex, comorbidity, hospital volume, and calendar period in relation to all-cause 90-day mortality (main outcome), 90-day reoperation, and prolonged hospital stay (≥2 days over median stay). Multivariable logistic regression provided odds ratios (ORs) with 95% confidence intervals (95% CI), adjusted for confounders. Among 26,193 patients who underwent primary laparoscopic antireflux surgery, postoperative 90-day mortality and 90-day reoperation rates were 0.13% (n= 35) and 3.0% (n= 750), respectively. The corresponding rates after secondary antireflux surgery (n= 1 618) were 0.19% (n= 3) and 6.2% (n= 94). Higher age (56-80 years vs 18-42 years: OR, 2.66; 95% CI 1.03-6.85) and comorbidity (Charlson Comorbidity Index ≥2 vs 0: OR, 6.25; 95% CI 2.42-16.14) increased risk of 90-day mortality after primary surgery, and higher hospital volume suggested a decreased risk (highest vs lowest tertile: OR, 0.58; 95% CI, 0.22-1.57). Comorbidity increased the risk of 90-day reoperation. Higher age and comorbidity increased risk of prolonged hospital stay after both primary and secondary surgery. Higher annual hospital volume decreased the risk of prolonged hospital stay after primary surgery (highest vs lowest tertile: OR, 0.74; 95% CI, 0.67-0.80). These findings suggest that laparoscopic antireflux surgery has an overall favorable safety profile in the treatment of gastroesophageal reflux disease, particularly in younger patients without severe comorbidity who undergo surgery at high-volume centers.

Highlights

BACKGROUND & AIMSAbsolute rates and risk factors of shortterm outcomes after antireflux surgery remain largely unknown
Decreased the risk of prolonged hospital stay after primary surgery. These findings suggest that laparoscopic antireflux surgery has an overall favorable safety profile in the treatment of gastroesophageal reflux disease, in younger patients without severe comorbidity who undergo surgery at high-volume centers
In an attempt to overcome these limitations of the existing evidence, we examined the absolute risks and risk factors for poor 90-day outcomes of primary laparoscopic antireflux surgery and secondary antireflux surgery from a modern period in a population-based multinational cohort

Summary

Introduction

Absolute rates and risk factors of shortterm outcomes after antireflux surgery remain largely unknown. We aimed to clarify absolute risks and risk factors for poor 90-day outcomes of primary laparoscopic and secondary antireflux surgery. Higher age (56-80 years vs 18-42 years: OR, 2.66; 95% CI 1.03-6.85) and comorbidity (Charlson Comorbidity Index 2 vs 0: OR, 6.25; 95% CI 2.42-16.14) increased risk of 90-day mortality after primary surgery, and higher hospital volume suggested a decreased risk (highest vs lowest tertile: OR, 0.58; 95% CI, 0.22-1.57). Higher age and comorbidity increased risk of prolonged hospital stay after both primary and secondary surgery. Absolute rates and risk factors of poor short-term outcomes after antireflux surgery remain largely unknown, but are important for clinical decision-making in patients with gastroesophageal reflux disease (GERD)

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