Antireflux surgery is a safe treatment option for gastroesophageal reflux disease (GERD), particularly in younger patients without severe comorbidity who undergo surgery at high-volume centers, according to results from a population-based cohort study published in Gastroenterology.
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 GERD. Researchers aimed to clarify absolute risks and risk factors for poor 90-day outcomes of primary laparoscopic and secondary antireflux surgery in patients who had primary laparoscopic or secondary antireflux surgery in the 5 Nordic countries (Norway, Sweden, Finland, Denmark, and Iceland) in 2000-2018.
They found that 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% (n=750), respectively. The corresponding rates after secondary antireflux surgery (n=1618) were 0.19% (n=3) and 6.2% (n=94).
Higher age and comorbidity increased the risk for 90-day mortality after primary surgery, and a higher hospital volume suggested a decreased risk. Comorbidity increased the risk for 90-day reoperation, whereas higher age and comorbidity increased the risk for a prolonged hospital stay after both primary and secondary surgery. A higher annual hospital volume decreased the risk for a prolonged hospital stay after primary surgery.
Among other limitations, the main limitation of the present study was the lack of direct data on covariates that might contribute to confounding, such as obesity and smoking.
The authors concluded, “These findings suggest that laparoscopic antireflux surgery has an overall favorable safety profile in the treatment of GERD, particularly in younger patients without severe comorbidity who undergo surgery at high-volume centers.”
Yanes M, Santoni G, Maret-Ouda J, et al. Mortality, reoperation and hospital stay within 90 days of primary and secondary antireflux surgery in a population-based multinational study. Gastroenterology. Published online February 12, 2021. doi:10.1053/j.gastro.2021.02.022