Andrea M Stroud, MD, MS, Alexa K Statz, BS, Xing Wang, PhD, Sally A Jolles, MA, Jacob A Greenberg, MD, EdM, Anne O Lidor, MD, MPH, Amber L Shada, MD, Daren C Jackson, PhD, Luke M Funk, MD, MPH. Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
INTRODUCTION– Laparoscopic antireflux surgery (LARS) is currently the gold standard treatment for refractory gastroesophageal reflux disease (GERD). Traditional surgical outcomes following LARS have been well described, but limited data exists regarding patient-reported outcomes. Specifically, little is known about the patient factors associated with a high quality of life after LARS. We aimed to identify preoperative characteristics that were independently associated with a high GERD health-related quality of life (GERD-HRQL) following LARS.
METHODS AND PROCEDURES– Clinical data from our single institution foregut surgery database were used to identify all patients with GERD who underwent primary LARS from June 2010 to November 2015. Electronic health record data were reviewed to extract patient demographics, comorbidities, medications, diagnostic study characteristics, and operative data. Post-operative GERD-HRQL, Gastroparesis Cardinal Symptom Index, and Eckardt dysphagia scores were obtained via telephone follow-up. Preoperative scores were obtained prospectively for patients who underwent surgery after the database was established (June 2014). Bivariate linear regression analysis was performed for variables hypothesized a priori to be associated with GERD-HRQL one year after antireflux surgery. Variables significant at p≤0.2 were entered into a multivariable linear regression model with GERD-HRQL as the outcome.
RESULTS– The study included 248 patients; 69.0% were female, 56.9% were married, and 58.1% had concurrent atypical symptoms. Nearly two-thirds had a type 1 hiatal hernia on the preoperative esophagram, while one-third had a type 3 hernia. The most commonly performed fundoplication was a Nissen (44.8%) followed by Toupet (41.3%) and Dor (14.1%). The median follow-up interval was 3.4 years, with a telephone response rate of 60.1%. GERD-HRQL scores improved from 24.8 (+/-11.4) preoperatively to 3.0 (+/-5.9) postoperatively. 79.9% of patients were satisfied with their condition at follow-up. On multivariable analysis, being married (p=0.04) and absence of depression (p=0.02) were independently associated with a higher postoperative quality of life (Table 1).
CONCLUSIONS– Social support and psychiatric well-being appear to be important predictors of a high quality of life following LARS. Focusing on strengthening social support and treating depression preoperatively, and maintaining those efforts postoperatively, may help optimize quality of life outcomes for patients who undergo LARS.
Table 1. Bivariate and Multivariable Characteristics Associated with a Higher Quality of Life after Laparoscopic Antireflux Surgery
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78013
Program Number: S088
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel