Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease in England. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Markar, Sheraz R.; Arhi, Chanpreet; Wiggins, Tom; Vidal-Diez, Alberto; Karthikesalingam, Alan; Darzi, Ara; Lagergren, Jesper; Hanna, George B.
• Is Part Of: Annals of surgery. Volume 271:Issue 4(2020)
• Publication Date: 2020-04
• Subjects: antireflux surgery -- gastro-esophageal reflux disease -- proton pump inhibitor therapy; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003131
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Background: After antireflux surgery, highly variable rates of recurrent gastroesophageal reflux disease (GERD) have been reported. Objective: To identify the occurrence and risk factors of recurrent GERD requiring surgical reintervention or medication. Methods: The Hospital Episode Statistics database was used to identify adults in England receiving primary antireflux surgery for GERD in 2000 to 2012 with follow-up through 2014, and the outcome was surgical reintervention. In a subset of participants, the Clinical Practice Research Datalink was additionally used to assess proton pump inhibitor therapy for at least 6 months (medical reintervention). Risk factors were assessed using multivariable Cox regression providing adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results: Among 22, 377 patients who underwent primary antireflux surgery in the Hospital Episode Statistics dataset, 811 (3.6%) had surgical reintervention, with risk factors being age 41 to 60 years (HR = 1.22, 95% CI 1.03–1.44), female sex (HR = 1.5; 95% CI 1.3–1.74), white ethnicity (HR = 1.71, 95% CI 1.06–2.77), and low hospital annual volume of antireflux surgery (HR = 1.32, 95% CI 1.04–1.67). Among 2005 patients who underwent primary antireflux surgery in the Clinical Practice Research Datalink dataset, 189 (9.4%) had surgical reintervention and 1192 (59.5%) used proton pump inhibitor therapy, with risk factors for the combined outcome being age >60 years (HR = 2.38, 95% CI 1.81–3.13) and preoperative psychiatric morbidity (HR = 1.58, 95% CI 1.25–1.99). Conclusion: At least 3.6% of patients may require surgical reintervention and 59.5% medical therapy following antireflux surgery in England. The influence of patient characteristics and hospital volume highlights the need for patient selection and surgical experience in successful antireflux surgery. Abstract : Supplemental Digital Content is available in the text