Early Reoperation and Readmission After Foregut Surgery for PEH and GERD

Daniel Boyett, MD, Daniela Molena, MD, Miloslawa Stem, MS, Anne O Lidor, MD, MPH. Johns Hopkins

Introduction: Current literature regarding reoperation and readmission for foregut surgery are limited due to small sample size and single center study designs. The aim of this study was to identify the incidence and factors associated with early related reoperation as well as underlying reasons for readmission following foregut surgery for PEH or GERD.

Methods and Procedures: Patients who underwent foregut surgery for GERD or PEH between 2010 and 2012 were identified from the Truven Health MarketScan database. The primary outcome was related reoperation and all cause readmission was the secondary outcome. Multivariable logistic regression analysis was used to identify factors associated with reoperation.

Results: 25,666 patients were identified and 72.9% had their initial surgery performed in an outpatient setting. Median follow up time was 16.5 months. 3,029 (11.8%) patients were readmitted during the study period on average 4.2 months postoperatively. Of these readmissions, 11.5% had recurrence of their preoperative condition, 6.07% had digestive system complications, and 3.9% had infectious complications. Of patients who required surgery during their first readmission (1,579, 6.2%), 18.6% underwent a revisional procedure. The overall related reoperation rate was 1.8% and was performed at a median of 4.5 months postoperatively. On adjusted analysis, factors associated with related reoperation included primary surgery performed in an inpatient setting and advanced age (Table).

Conclusion: Early reoperation and readmissions are significant morbidities associated with foregut surgery for PEH and GERD. This study reveals an association between these significant morbidities and with the primary procedure being performed in an inpatient setting and advanced patient age.

Factors associated with related reoperation following foregut surgery for PEH or GERD
Characteristric OR (95% CI) p
Setting, n (%)    
     Outpatient Ref  
     Inpatient 2.80 (2.24-3.48) <0.001
Age, n (%), y    
     18-34 Ref  
     35-44 1.34 (0.91-1.96) 0.141
     45-54 1.60 (1.12-2.30) 0.011
     55-64 1.57 (1.10-2.34) 0.013
Procedure type, n (%)    
     Lap Nissen Ref  
     Open Nissen 1.20 (0.86-1.68) 0.278
     Lap PEH 0.85 (0.68-1.06) 0.140
     Open PEH 0.87 (0.59-1.30) 0.504

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