The utilization of laparoscopy in the treatment of achalasia: an outcomes analysis using ACS-NSQIP data

Chetan V Aher, MD, John C Kubasiak, MD, Imke Janssen, PhD, Daniel J Deziel, MD, Keith W Millikan, MD, Jonathan A Myers, MD, Minh B Luu, MD. Rush University Medical Center

Introduction

Laparoscopic Heller myotomy (LM) has been shown in previous meta-analyses and case series from high-volume centers to have fewer complications, decreased length of stay, and better patient satisfaction when compared with open Heller myotomy (OM) for the treatment of achalasia. Overall utilization of laparoscopy, mortality, and morbidity rates from the ACS-NSQIP dataset have not been reported for the treatment of achalasia.

Methods

A retrospective review of the ACS-NSQIP database from 2009-2012 was conducted. All patients diagnosed with achalasia undergoing LM vs. OM were included. The primary outcome was utilization of laparoscopy. Secondary outcomes were mortality and associated 30-day morbidity, which included return to OR, surgical site infection, postoperative pneumonia, urinary tract infection, transfusion, and sepsis. Outcomes were compared using chi-square tests for categorical variables and 2-sided t-tests for continuous variables. Secondary outcomes (mortality and complications) were further analyzed using logistic regression analysis.

Results

Within the study period, 1,465 patients undergoing trans-abdominal operative intervention for achalasia were identified. LM was performed on 92% of patients. There were no differences in patient comorbidities and demographics between the LM and OM groups. The overall mortality was 0.15% for LM and 0% for OM. The overall morbidity was 3.5% for LM and 4.8% for OM. In the logistic regression model analysis, overall complication rates were not statistically different (p=0.49). There were no differences in return to OR, surgical site infection, postoperative pneumonia, urinary tract infection, transfusion or sepsis.

Conclusion

According the ACS-NSQIP dataset, utilization of laparoscopy in the treatment of achalasia is 92%. Despite the high adoption rate of laparoscopy in the treatment of achalasia, no statistically significant difference in perioperative outcomes was demonstrated.

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