ACS NSQIP Analysis: Risk Factors for Complications After Laparoscopic and Open Antireflux Surgery.

Subhash Reddy, MD, Jonathan Grotts, MA, David Thoman, MD

Santa Barbara Cottage Hospital

Background:
Antireflux surgery and paraesophageal hernia repair are increasingly done in the elderly and those with multiple comorbidities. We sought to identify risk factors for adverse postoperative events after open or laparoscopic fundoplication by querying a large national database.

Methods:
Under the data use agreement for the American College of Surgeons National Surgical Quality Improvement (NSQIP) Program Public Use File, and with the institutional review board approval, we reviewed perioperative variables of patients who underwent fundoplication with or without paraesophageal hernia repair from 2006 to 2010. Patients who underwent a revision of a previous fundoplication or fundoplication for Heller myotomy as the principal procedure were excluded. The primary endpoint was mortality and secondary endpoints included post-operative adverse events. A multivariate model was used to control for pre-operative morbidity, age and BMI. Odds ratio, Chi square, logistic regression were performed using SPSS 2011.

Results:
Of 6,667 fundoplications analyzed, 5,571 (83.5%) were laparoscopic fundoplications and 1,725 paraesophageal hernia repairs. Overall, patients who had an open approach had more comorbidities than laparoscopic group. Using multivariate logistic regression preoperative variables likes Age > 70, and sepsis were independently associated with mortality, respiratory, urinary complications and transfusion requirements (P< 0.05), BMI >30 and steroids (P<0.05) were associated with wound infections. Laparoscopic procedure (p<0.05) showed protective effect for all post operative complications. Respiratory and cardiac comorbidities were not independently associated with postoperative adverse events (p> 0.05). Demographics and adverse events are summarized in the attached table.

Demographics and Adverse events with P value

Variables

Open

(n=1096)

Laparoscopic

(n=5571)

p value
Mean Age 62.7 years 55.4 years 0.001
Male 410(37.4%) 1999(35.8%) 0.29
Mean BMI 29.1 29.7 0.001
Mean Operation Time 96 minutes 75 minutes 0.001
Total Length of Stay 5 days 2 days 0.001
Wound Class- Contaminated 34(3.1%) 61(1.1%) 0.001
Postooperative Wound Infection 86(7.8%) 5491%) 0.001
Postoperative Respiratory events 69(6.4%) 75(1.3%) 0.001
Postoperative Cardiac events 3 7 0.3
Return to OR in 30 days 52(4.7%) 91(1.6%) 0.001
Blood Requring Transfusions 21(1.9%) 25(0.4%) 0.001
Mortality 21(1.9%) 17(0.3%) 0.001

Conclusion:
Patients undergoing open fundoplication are of a higher acuity then patients undergoing laparoscopy. After controlling for risk factors, an open procedure does not result in higher mortality, but is associated with significantly increased morbidity.


Session: Podium Presentation

Program Number: S094

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