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IMPROVEMENTS IN GERD-RELATED QUALITY OF LIFE AFTER PRIMARY ANTIREFLUX SURGERY DECLINE SLIGHTLY IN THE LONG-TERM (72 MONTHS)
Andrés R. Latorre-Rodríguez
*2,3, Mark Shacker
1, Austin Reynolds
1, Sumeet K. Mittal
2,11Creighton University School of Medicine Phoenix Health Sciences Campus, Phoenix, AZ; 2Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ; 3Universidad del Rosario. Escuela de Medicina y Ciencias de la Salud, Grupo de Investigación Clínica, Bogotá D.C., Colombia
Background: The overarching goal of antireflux surgery (ARS) (e.g., total or partial fundoplication) is to control reflux episodes and pathological esophageal acid exposure; however, other outcomes, such as quality of life (QoL) and patient satisfaction have recently gained relevance in surgical practice. We aimed to compare short-, mid-, and long-term patient-reported QoL in terms of specific GERD-related symptoms among patients who underwent primary ARS.
Methods: We queried a prospectively maintained database regarding all patients who underwent primary ARS by a single foregut surgeon between September 2016 and July 2023. Patients were categorized into 3 groups based on the time to the last follow-up including assessment with the validated GERD Health-Related Quality of Life (GERD-HRQL) questionnaire: Group A, short-term follow-up (≤24 months), Group B, mid-term follow-up (≥24 and <48 months), and Group C, long-term follow-up (≥48-72 months). Groups were compared using the Chi-square or the Kruskal-Wallis tests as appropriate. The significance level (α) was set at 0.05.
Results: Of 377 patients who underwent primary ARS during the study period, a total of 143 (37.9%) completed both preoperative and postoperative GERD-HRQL questionnaires within 72 months. Most were female (n=107, 74.8%), the mean age was 65.4±12.3 years, and the mean BMI was 28.3±4.2 kg/m
2. The distribution between groups was: A (n=42, 29.4%), B (n=65, 45.6%), and C (n=36, 25.2%). Demographic and anthropometric characteristics were similar between the groups. Preoperative total GERD-HRQL scores were also comparable across the groups (A: 27.4±20.3 vs. B: 27.1±19.1 vs. C: 28.5±18.4, P=0.958), as were the specific component scores (i.e., heartburn [P=0.612], dysphagia [P=0.998], and regurgitation [P=0.908]). All groups reported improved QoL after ARS; however, the heartburn component score (A: 1.9±4.1 vs. B: 3.8±6.3 vs. C: 4.8±6.3, P=0.030) was significantly higher among patients who reached long-term follow-up. Similarly, the total GERD-HRQL score (A: 5.1±8.6 vs. B: 9.2±14.3 vs. C: 10.1±13.1, P=0.345), the regurgitation score (A: 1.7±4.0 vs. B: 3.5±6.3 vs. C: 3.8±6.3, P=0.169), and the proportion of patients using proton-pump inhibitors (PPIs) (A: 11.9% vs. B: 21.5% vs. C: 25.7%, P=0.279) trended upward over time. The postoperative dysphagia scores were similar between the groups (A: 1.4±2.0, B: 1.3±2.4 and C: 1.2±1.7, P=0.628).
Conclusion: Patients continue to report significant improvement in GERD-HRQL compared to preoperative scores for up to 72 months of follow-up. However, a small increase in recurrent reflux as evidenced by an increase in heartburn and regurgitation scores as well as the use of PPIs was noted longitudinally. Dysphagia scores were stable over time.
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