Laparoscopic antireflux surgery safe, especially for young patients with no comorbidities

Laparoscopic antireflux surgery is a safe procedure overall, especially in young patients with no severe comorbidities, a recent study has found. High-volume centres, likely because of the experience of their surgical teams, also deliver better results.

Researchers conducted a population-based cohort study of 26,193 patients (median age 50 years, 53 percent women) who had undergone primary laparoscopic antireflux surgery. The primary outcome was 90-day mortality, as well as its potential predictors. Other endpoints included 90-day reoperation and prolonged hospital stay extending ≥2 days over the median stay.

Thirty-five participants died of any cause in the 90 days after operation, yielding an overall rate of 0.13 percent. Such an outcome was more than twice as likely to occur among participants in the topmost age tertile (56–80 vs 18–42 years: odds ratio [OR], 2.66, 95 percent confidence interval [CI], 1.03–6.85).

The risk was also significantly exacerbated in patients with Charlson Comorbidity Index (CCI) scores ≥2 vs 0 (OR, 6.25, 95 percent CI, 2.42–16.14). Patient sex and annual hospital volume did not affect the 90-day mortality endpoint.

Higher comorbidity burden also led to a significantly higher odds of 90-day reoperation (CCI 1 vs 0: OR, 1.29, 95 percent CI, 1.05–1.58) and prolonged hospital stay (CCI ≥2 vs 0: OR, 2.38, 95 percent CI, 1.98–2.85).

In addition, patient age and sex were significant risk factors for longer hospital stay. Notably, hospital volume had an inverse effect: a higher annual volume was protective against prolonged hospital stay, likely due to the experience of their surgical and care teams (OR, 0.97, 95 percent CI, 0.71–1.31).