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- Maret-Ouda, John, et al.
(author)
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Mortality from laparoscopic antireflux surgery in a nationwide cohort of the working-age population
- 2016
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In: British Journal of Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0007-1323 .- 1365-2168.
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Journal article (peer-reviewed)abstract
- Background: Effective treatment of severe gastro-oesophageal reflux disease is available through medication or surgery. Postoperative risks have contributed to decreased use of antireflux surgery. We aimed to assess short-term mortality following primary laparoscopic fundoplication. Method: Population-based nationwide Swedish cohort study including all Swedish hospitals performing laparoscopic fundoplication, between 1997 and 2013. All patients aged 18-65 years with gastro-oesophageal reflux disease who underwent primary laparoscopic fundoplication during the study period were included. Main outcome was absolute all-cause and surgery-related 90-day and 30-day mortality. Secondary outcomes were reoperation and length of hospital stay. Logistic regression was used to calculate odds ratios with 95% confidence intervals of reoperation within 90 days and prolonged hospital stay (>4 days). Results: Of 8947 included patients, 5306 (59.3%) were men, and 551 (6.2%) had a significant comorbidity (Charlson comorbidity score >0). Median age at surgery was 48 years, and median hospital stay was 2 days. Annual rate of laparoscopic fundoplication decreased from 15.3 to 2.4 cases per 100 000 inhabitants during the study period, while the proportion of patients with comorbidity increased more than 2-fold. All-cause 90- and 30-day mortality were 0.08% (n=7) and 0.03% (n=3), respectively. Only 1 death (0.01%) was directly surgery-related. 90-day reoperation rate was 0.4% (n=39). Comorbidity and higher age entailed increased risk for prolonged hospital stay, but not for reoperation. Conclusion: This population-based study revealed a remarkably low 90-day mortality and reoperation rate following laparoscopic, results which might influence clinical decision-making in the treatment of severe gastro-oesophageal reflux disease.
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