NATIONAL TRENDS AND OUTCOMES IN UTILIZATION OF FUNDOPLICATION PROCEDURES FOR GERD.
Muhammad Haseeb*2,1, Zubair Khan3, Pichamol Jirapinyo1, Christopher C. Thompson1
1Brigham and Women's Hospital, Boston, MA; 2Harvard Medical School, Boston, MA; 3The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, TX
Background and Aims: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal tract diseases with high associated health care costs. The primary treatment is medical therapy with proton pump inhibitors (PPI). Though relatively safe and effective, PPI can have side effects with long-term use prompting the search for alternative treatment modalities. Our study aims to assess trends and periprocedural outcomes in the utilization of Laparoscopic Fundoplication (LF), Open Abdominal/Thoracic Fundoplication (OF), and Endoscopic Fundoplication (EF).
Methods: The 2016-2019 National In-Patient Sample was queried using ICD-10-CM Codes to identify a cohort of inpatient elective adult admissions with a primary or secondary diagnosis of GERD-related symptoms who underwent anti-reflux procedures LF, OF, or EF. Admissions were excluded with esophageal carcinoma, achalasia, and hernia with gangrene or obstruction. A weighted sample was used to get national inpatient procedure counts. We used the denominator for each year from adult population estimates of the U.S. Census Bureau for estimating procedure rates.
Results: The annual population-based rate of inpatient anti-reflux procedures decreased from 2016 (65 procedures per million adults) to 2019 (55.9 procedures per million adults). The EF showed a trend of decreased utilization from 2016 to 2019, and the population-based rate was significantly lower than LF (e.g., 57.6 LF vs. 1.7 EF per million adults for the year 2016). The annual trends of inpatient anti-reflux procedures using fundoplication are shown in Figure 1. The mean age of the population in this cohort was about 60 years, with female gender and Caucasian race predominance (Table 1). The Charlson comorbidity index (CCI) was higher for patients undergoing OF than patients undergoing EF. A significant proportion of EF cases were performed in non-teaching hospitals as compared to other procedures (~ 39 % EF vs. 23 % LF and 22% OF). More patients who underwent EF were insured by private insurance. The risk of periprocedural events and complications was higher with OF but was statistically significant only for procedure-related bleeding as compared to other procedures. Similarly, the length of stay and total charges was also higher for patients undergoing OF.
Conclusion: In the United States, the overall trend of anti-reflux procedures in general and EF in specific is declining in the hospitalized cohort. This trend can be explained partly by the improved expertise of surgeons and gastroenterologists with anti-reflux procedures, resulting in number of these procedures being done in outpatient settings. In conclusion, EF remains underutilized in this cohort despite lower periprocedural events, complications, and health care costs. EF is also more common in those with private insurance suggesting a potential health care disparity.
Back to 2022 Abstracts