TRENDS AND OUTCOMES OF INTRAOPERATIVE ESOPHAGOGASTRODUODENOSCOPY DURING MINIMALLY INVASIVE HELLER MYOTOMY: A NSQIP ANALYSIS
Paul Wisniowski*, Luke R. Putnam, Shivani Sundaram, Caitlin C. Houghton, John C. Lipham
Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA
Purpose: Since 2011, nationally-recognized guidelines have recommended the use of intraoperative esophagogastroduodenoscopy (iEGD) during minimally invasive heller myotomy (MHM) to detect intraoperative leaks and prevent esophageal narrowing. Data regarding the application of these guidelines have not been reported. The purpose of this study is to evaluate the frequency of guideline adherence and rates of complications in patients undergoing MHM with and without iEGD.
Methods: The 2011-2020 National Surgical Quality Improvement Program (NSQIP) registry was utilized to evaluate patients undergoing MHM with or without iEGD. Trends, perioperative outcomes, and 30-day complications were examined using univariable analysis and multivariable regression.
Results: A total of 4,631 MHM patients were identified; 895 (19.3%) with concomitant iEGD, and 3735 (80.7%) without iEGD. Patient demographics including age, body mass index, gender, and race/ethnicity were similar between groups (all p>0.05). In patient undergoing iEGD, operative time was longer 150 ± 65 minutes vs 137 ± 58 minutes (p<0.001), but there was no difference in mean length of stay 2.0 ± 2.7 days vs 1.7 ± 4.1 days (p=0.052), or overall complication rate 50 (5.6%) vs 197 (5.3%) (p=0.708). The frequency of iEGD during MHM did not increase during the study period (Figure 1, p=0.658). Postoperatively, fewer iEGD patients suffered from pneumonia 2 (0.2%) vs 36 (1.0%), p=0.027, which remained statistically significant after multivariable regression (OR 0.191, 95% CI 0.045-0.808, p=0.024).
Conclusion: Despite 10 years of national guidelines encouraging the use of intraoperative EGD during minimally invasive heller myotomy, practice patterns have not appeared to change. This robust database of 30-day outcomes suggests iEGD is associated with decreased postoperative pneumonia, so further efforts to promote adherence to the guidelines may be warranted.
Trends if iEGD in MHM over 10 years
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