SP6.7 Variation in UK anti-reflux surgery practice - A Collaborative Multicentre National Audit (ARROW study)

Abstract

Abstract Aims There is significant variation in the work-up of patients for anti-reflux surgery. This study describes the current variation in UK work up and perioperative management for anti-reflux surgery (ARS), and adherence to clinical guidelines. Methods A 12-month UK-wide multicentre prospective national audit was undertaken using a secure online platform. Data collection included demographics, symptoms, pre-operative investigations, intraoperative details, and postoperative outcomes within 90 days. Audit standards (AS) were taken from BSG, ICARUS and AUGIS guidelines. Results 630 patients from 38 centres were analysed. Patients had a median age 58 years (18-92, F:M 384:245), median ASA 2, and median BMI 29kg/m2. Oesophageal manometry was performed in 332 patients (54%, AS 100%). Twenty-four-hour pH monitoring was performed in 319 patients (53%, AS 100%). Endoscopy was performed in 520 patients (83%, AS 100%). Laparoscopic or robotic surgery was recorded in 506 and 63 patients, respectively (99%, AS 95%). Two patients underwent open surgery and four laparoscopic cases converted to open. Only 3% (22) patients were day-cases. Overall, 45 patients were re-admitted (7%, AS <10%); three units had a >10% readmission rate which corresponded with high day-case rates. Less than one percent of patients had an unplanned re-operation. Of those with recorded follow up (60%), 94% had recorded full/partial resolution of symptoms; 86% having nil further requirement for PPI. Conclusions There is wide variation in practice, especially regarding preoperative work up, adherence to existing guidelines and low day-case rates. More work is required to assess how the variation in practice affects patient outcomes.