Twenty-year Trend in the Utilization of Heller Myotomy for Achalasia in the United States

Jennifer Preston, MD, James Dolan, MD, John Hunter, MD, Brian Diggs, PhD. Oregon Health & Science University.

Background: The objective of this study was to determine the U.S. national trend in the utilization of Heller myotomy (HM) for achalasia over a twenty year period.

Methods: Using the Nationwide Inpatient Sample (NIS) of between 6 and 8 million patient records per year, we extracted and analyzed data for achalasia and HM during the years 1991-2011. We then used procedure specific codes to calculate the national estimates for HM for the time under review. We cross referenced this data with laparoscopic procedure codes to evaluate changes in technique. Finally we analyzed patient, institutional and outcome characteristics as well as in-patient mortality.

Results: The total number of HM performed nationally has increased steadily over the last twenty years (1342 cases in 1991 to 5046 cases in 2011) and the percentage of laparoscopic HMs has also increased. In addition, HMs have increased in frequency at urban teaching hospitals as compared to urban non-teaching hospitals (40% vs 49% in 1991 to 78% vs 18% in 2011, p<0.001). Conversely, the in-hospital mortality rate has decreased over this period of review (average mortality of 0.95% for 1991-1995 and 0.29% for 2007-2011, p=0.0056). The median length of hospital stay (LOS) has also decreased (7 days in 1991 to 2 days in 2011, p<0.001). The majority of patients returned home following discharge (range 86% to 95%).

Conclusion: These data show an increase in the number of HMs performed between 1991 and 2011 in the U.S. There has also been an increased utilization of the laparoscopic approach and an increase in the percentage of procedures done in urban teaching hospitals. Patient outcomes have improved over this time period, including decreased in-hospital mortality and LOS, and consistently high rates of discharge to home.

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