Charges, Complications, and Outcome: A Comparison of Laparoscopic Nissen Fundoplication versus Magnetic Sphincter Augmentation for GERD

Jessica L Reynolds, MD, Joerg Zehetner, MD, Angela Nieh, MS, Nikolai Bildzukewicz, MD, Kuleet Sandhu, MD, Peter Crookes, MD, John C Lipham, MD. University of Southern California

Introduction: Magnetic sphincter augmentation (MSA) with the LINX Reflux Management System has been approved for mild to moderate gastro-esophageal reflux disease (GERD) since 2012. Multiple studies have shown MSA to compare favorably to laparoscopic Nissen fundoplication (LNF) in terms of symptom control with results out to 5 years. However, the LINX device itself is costly and this has been a barrier to insurance coverage and therefore more widespread usage. The aim of the study was to assess charges, 30-day complications and outcomes at 1 year of LNF versus MSA.

Material and Methods: This is a retrospective analysis of patients who underwent MSA vs LNF between January 2008 and June 2013 at two hospitals. We included all MSA and LNF patients who met criteria for MSA under the LINX FDA approval. Patient charges were collected for the surgical admission and broken down into categories including pharmacy, billable supplies, lab services, operating room charges, anesthesia, and the charges of the hospital/recovery/observation room. We also collected data on 30-day complications and symptom control at 1 year assessed by GERD-HRQL score and PPI use.

Results: There were 144 patients included in the study, 90 LNF and 54 MSA. There was no significant difference between the mean charges for LNF and MSA, $44,380 vs $47,534, p=.260 (Table 1). The only significant difference in mean charges was for room and board with $5,745 for LNF and $1,329 for MSA, p=.002. There were also significant differences in OR time (79 min LNF vs 68 min MSA, p=.003) and LOS (37h LNF vs 16h MSA, p<.001). 1-year GERD-HRQL scores and PPI use were available for 106/144 patients (73.6%) with no significant difference. Mean GERD-HRQL was 4.5 for LNF vs 4.9 MSA, p= .758 and frequency of PPI use was 7/66 (10.6%) for LNF vs 6/40 (15.0%) for MSA (p=.550). 30-day complications between the 2 groups were similar with 1 urinary retention and 1 readmission for post-operative vomiting in the LNF group and 2 urinary retentions in the MSA group.

Conclusion: LNF and MSA are comparable in symptom control, safety, and overall hospital charges. The charge for the LINX device is offset by the shorter hospitalization.

LNF (n=90) LINX (n=54) P Value
Table 1 Comparison of charges, OR time and LOS for LNF vs MSA
Total Charges ($) 44,380 47,534 0.260
Billable Supplies 15,149 22,815 0.240
Pharmacy and Drugs 3,710 1,623 0.279
Laboratory 1,609 834 0.515
OR services 18,988 15,326 0.127
Anesthesia 3,105 2,369 0.149
Room and Board 5,745 1,329 0.002
OR time (min) 79 68 0.003
Length of Stay (hours) 37 16 <0.001

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