Antireflux Surgery Is Associated With a Low 90-Day Mortality Rate in Patients With GERD

Laparoscopic antireflux surgery (ARS) is an effective treatment for patients with well-documented gastroesophageal reflux disease (GERD). In this retrospective cohort study, investigators used national databases from 5 Nordic countries to determine the 90-day mortality, readmission rates, and length of hospitalization after primary laparoscopic fundoplication (PLF) and secondary ARS (laparoscopic or open surgery after PLF). 

During the years 2000 to 2018, 26,193 patients underwent PLF (median age, 50 years; 47% male; 85% had Charlson Comorbidity Index [CCI] 0) and 1618 patients underwent secondary ARS (median age, 53 years; 43% male; 79% had CCI 0). The rates of absolute all-cause 90-day mortality and reoperation, as well as the median length of hospital stay (LOS) for PLF were 0.13%, 3%, and 3 days, respectively. The rates were similar with secondary ARS at 0.19%, 6.2%, and 4 days, respectively. 

The 90-day mortality after PLF was significantly higher in older patients (aged 56-80 years vs 18-42 years: odds ratio [OR], 2.66; 95% confidence interval [CI], 1.03-6.85) and those with more comorbidity (CCI ≥2 vs 0: OR, 6.25; 95% CI, 2.42-16.14), whereas higher hospital surgical volume suggested a lower risk (highest vs lowest tertile: OR, 0.58; 95% CI, 0.22-1.57). Patient comorbidity was the only factor associated with an increased risk of reoperation after PLF (CCI ≥2 vs 0: OR, 1.47; 95% CI, 0.97-2.23 and CCI 1 vs 0; OR, 1.29; 95% CI, 1.05-1.58). Prolonged hospital stay (>1 day longer than median LOS) was seen in 20% and 29% of patients after PLF and secondary ARS, respectively. Older age (OR, 1.48; 95% CI, 1.37-1.61) and female gender (OR, 1.09; 95% CI, 1.02-1.16) were associated with a higher risk of prolonged LOS, and hospital volume was associated with a lower risk of prolonged LOS (OR, 0.74; 95% CI, 0.67-0.80).