Laparoscopic vs. open antireflux surgery linked to improved outcomes, lower costs
A retrospective population-based study revealed associations between laparoscopic antireflux surgery and fewer postoperative complications, shorter hospital stays and lower health care costs vs. open procedures.
“Our study highlights the fact that laparoscopic antireflux surgery is as effective as the open approach, and in 2017, with all its advantages, should be the standard of care,” Marco G. Patti, MD, FACS, a surgeon and director of the Center for Esophageal Diseases and Swallowing at University of North Carolina, Chapel Hill, said in a press release. “We found that laparoscopic surgery is associated with significantly lower costs. In addition, indirect costs of the open approach, including an impaired ability to work, time off from work, and intangible costs of postoperative pain and healing, are difficult to measure but also favor the laparoscopic approach.”
Patti and colleagues identified 75,544 adults with GERD within the National Inpatient Sample who underwent laparoscopic (n = 44,089; 58.4%) or open fundoplication (n = 31,455; 41.6%) between 2000 and 2013, and performed multivariable linear and logistic regression analyses to compare perioperative outcomes between the two procedures.
They found that the rate of laparoscopic procedures increased from 24.8% in 2000 to 84.3% in 2013 (P < .0001).
“Surprisingly, in 2003, 12 years after the first laparoscopic antireflux operation was reported, only 25% of all the antireflux operations were performed laparoscopically in the U.S.,” Francisco Schlottmann, MD, a surgeon at the Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, said in the press release. “Subsequently, the rate increased, but 15% of all antireflux operations were still being performed through an open approach in 2013. We believe this percentage is very high, and we hope that in the next year this percentage will decrease.”
Overall, 7,616 (10.1%) complications occurred during index hospitalizations. After adjusting for patient and hospital characteristics, the investigators found that laparoscopic procedures were associated with lower risks for postoperative venous thromboembolism (OR = 0.82; 95% CI, 0.73-0.92), wound complications (OR = 0.3; 95% CI, 0.22-0.39), infection (OR = 0.33; 95% CI, 0.28-0.38), esophageal perforation (OR = 0.43; 95% CI, 0.36-0.51), bleeding (OR = 0.33; 95% CI, 0.3-0.36), cardiac failure (OR = 0.67; 95% CI, 0.6-0.75), renal failure (OR = 0.48; 95% CI, 0.42-0.56), respiratory failure (OR = 0.48; 95% CI, 0.43-0.54), shock (OR = 0.41; 95% CI, 0.32-0.53) and inpatient mortality (OR = 0.46; 95% CI, 0.32-0.53) compared with open procedures.
Additionally, they determined that laparoscopic procedures were associated with shorter hospital stays compared with open procedures (mean reduction, 2.1 days), and lower hospital charges (mean reduction, $9,530).
These results confirm findings of previous studies.
“Some opponents of [laparoscopic antireflux surgery] argue that it is less effective than the open approach, and the risk of treatment failure outweighs the short-term benefits related to minimally invasive surgery,” the investigators wrote. “Nevertheless, previous reports have reported no significant differences in long-term reflux control and patient satisfaction with surgery between laparoscopic and open fundoplication.”
The investigators also noted that their results showed urban academic or teaching hospitals performed laparoscopic antireflux surgery more often than open procedures (54.4% vs. 45.6%).
“We think that it is important to make this information more available to the public. In order to achieve good outcomes, antireflux surgery should be performed laparoscopically in specialized centers,” Patti said in the press release. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.