TEMAS LIBRES
Cirugía General Cirugía esofagogastroduodenal

TITULO: SURGICAL TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE: IMPACT OF SURGICAL VOLUME ON PERIOPERATIVE OUTCOMES AND COSTS 

AUTORES: FRANCISCO SCHLOTTMANN, RUDOLF BUXHOEVEDEN, PAULA STRASSLE, MARCO G. PATTI, DANIELA MOLENA

Nº DE REFERENCIA 15236

TIPO PRESENTACION: Temas Libres

CATEGORIA: Cirugía General

SUBCATEGORIA: Cirugía esofagogastroduodenal

RESUMEN DE LA PRESENTACION: 

ANTECEDENTES: Previous reports have shown a decline in the number of antireflux procedures in the last decade. While this drop may be in part explained by the obesity epidemic and the rapid increase in the utilization of bariatric surgery, concerns about surgical results in non-specialized centers may have played an important role in this decline. 

OBJETIVO: We aimed to analyze the impact of surgical volume on perioperative outcomes and costs for patients undergoing antireflux surgery.

DISEÑO: Retrospective analysis of the Nationwide Inpatient Sample 

MATERIAL Y METODO: We performed a retrospective analysis of the Nationwide Inpatient Sample from 2000 to 2013. Adult patients (≥ 18 years old) with gastroesophageal reflux disease who underwent fundoplication were included. Hospital surgical volume was determined using the 30th and 60th percentile cut points using weighted discharges. Surgical volume was categorized as small (<10 operations/year), intermediate (10-25 operations/year), or high (>25 operations/year). Linear and logistic regression, adjusted for patient demographics, comorbidities, hospital characteristics and laparoscopic approach, were used to assess the effect of surgical volume on patient outcomes and determine the charges for health care.

RESULTADOS: A total of 75,544 patients were included. Patients at low volume hospitals, compared to high volume were more likely to have postoperative bleeding, cardiac failure, renal failure, respiratory failure and inpatient mortality. Patients receiving care at an intermediate volume hospital, compared to high volume presented higher incidence of postoperative infection, esophageal perforation, bleeding, cardiac failure, renal failure and respiratory failure. On average, patients at low volume hospitals stayed 1.08 days longer and patients at intermediate volume hospitals stayed 0.55 days longer. Adjusted change in estimate charges analysis showed an increase of 5,120 dollars per patient in low volume centers and an increase of 4,010 dollars per patient in intermediate volume centers.

CONCLUSIONES: High surgical volume is related to a significant decrease of perioperative morbidity, shorter length of hospital stay, and lower costs for the health care system. Centralization of antireflux procedures in high volume centers should be considered to achieve better perioperative outcomes and to avoid higher expenses.


 


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