title: Laparoscopic improves perioperative outcomes of antireflux surgery at US academic centers.
abstract: BACKGROUND
  Open and laparoscopic antireflux surgeries are standard for the treatment of gastroesophageal reflux disease (GERD). The in-hospital outcomes of laparoscopic and open antireflux procedures were analyzed and compared at US academic medical centers.
  
  
  METHODS
  Using International Classification of Diseases, Ninth Revision, Clinical Modification codes for 5,737 patients with GERD that underwent open (n = 1,377) or laparoscopic (n = 4,360) antireflux surgery were identified from the University Health-System Consortium Database over a 3-year period (2004-2007). Demographic and outcome data measured included length of stay, overall complications, in-hospital mortality, observed-to-expected mortality ratio (risk-adjusted mortality), and hospital costs.
  
  
  RESULTS
  Laparoscopic antireflux procedures offered significantly lower mean length of stay, in-hospital morbidity, and hospital costs. Both procedures had a low observed to expected in-hospital mortality. Open surgery was associated with significantly higher procedure-related and pulmonary complications.
  
  
  CONCLUSIONS
  In the context of US academic centers, approximately three quarters of antireflux procedures are being performed using the laparoscopic approach. These data suggest that laparoscopy has improved in-hospital outcomes when compared with open surgery and is preferred for the surgical treatment of GERD.
authors.affiliation: Surgical Service, Veterans Affairs North Texas Health Care System, 4500 South Lancaster Road (112), Dallas, TX 75216, USA. esteban.varela@utsouthwestern.edu
authors.forename: J Esteban
authors.initials: JE
authors.lastname: Varela
authors.forename: Marcelo W
authors.initials: MW
authors.lastname: Hinojosa
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005764:Gastroesophageal Reflux / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult