Oliver Varban, MD, Jyothi Thumma, MPH, Dana Telem, MD, MPH, Nabeel Obeid, MD, Jonathan Finks, MD, Amir Ghaferi, MD, MS, Justin Dimick, MD, MPH. University of Michigan
Background: Prior studies have demonstrated an increase in gastroesophageal reflux after laparoscopic sleeve gastrectomy. However, it is unknown to what degree patient reflux severity varies by surgeon.
Methods: The GERD-HRQL, a validated gastroesophageal reflux symptom survey, was administered at baseline and at 1 year after primary sleeve gastrectomy to 7,358 patients between 2013 and 2018 participating in a state-wide quality improvement collaborative. Patients with an increase in score from baseline to 1-year post-surgery (ie. worsening of symptoms) were divided into terciles based on the degree of change in their score and surgeons were grouped into terciles based on the proportion of their patients reporting mild, moderate and severe symptoms. Surgeon-level data including operative volume, operative time, years in practice, fellowship training and type of practice (teaching vs non-teaching), was obtained on 52 bariatric surgeons performing at least 25 sleeve gastrectomy cases/year during the study period. Surgeon characteristics, risk-adjusted 30-day complication rates and rates of concurrent hiatal hernia repair and post-operative endoscopic dilation at 1-year after surgery were compared between surgeons in the highest and lowest terciles based on symptom severity.
Results: A total of 2,294 (31.2%) patients had worsening symptoms of reflux after sleeve gastrectomy. Overall mean increase in severity score was 6.11 (range 1 to 48) and patients with mild, moderate and severe symptoms had a mean increase of 1.4, 4.2 and 13.8, respectively. Surgeons varied in the proportion of patients with mild (11.8%-66.7%) moderate (0%-50%) and severe reflux (7.7%-66.7%). There were no significant differences in surgeon-specific characteristics when comparing surgeons in the highest tercile for severe worsening of symptoms (44.7%) vs those in the lowest tercile (18.7% of patients). In addition, there were no significant differences in risk-adjusted rates of overall complications (3.70% vs 4.33%, p=0.686), endoscopic dilations (2.83% vs 1.91%, p=0.417) or concurrent hiatal hernia repair (34.3% vs 27.0%, p=0.415) between surgeons in the highest and lowest terciles.
Conclusions: In this state-wide analysis, we found that symptom severity for worsening reflux after sleeve gastrectomy varied among patients and that the proportion of patients reporting severe symptoms varied considerably by surgeon. Surgeons in the highest and lowest terciles for severe symptoms, however, did not differ by operative volume, training, experience or complication rates, suggesting that differences in surgical technique may explain some of the variation in reflux severity after sleeve gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94024
Program Number: S138
Presentation Session: Bariatric V – GERD and Esophageal Physiology
Presentation Type: Podium