title: Elective antireflux surgery in the US: an analysis of national trends in utilization and inpatient outcomes from 2005 to 2010.
abstract: BACKGROUND
  Previous research suggested that antireflux surgery reached its peak volume in the US more than a decade ago. Factors such as changes in population demographics and improvements in surgical outcomes may have reversed this decline. We sought to examine national trends in the management of antireflux surgery patients and identify patient and hospital characteristics associated with postoperative complications.
  
  
  METHODS
  We analyzed data from the Nationwide Inpatient Sample to identify adults with gastroesophageal reflux disease or esophagitis who underwent elective antireflux surgery between 2005 and 2010. Patient and hospital characteristics were analyzed. A multivariate logistic regression model was used to identify characteristics associated with an increased risk of postoperative complications following laparoscopic antireflux surgery.
  
  
  RESULTS
  The volume of elective antireflux surgery remained relatively stable between 2005 (n = 15,819) and 2010 (n = 18,780). The percentage of patients older than 64 years of age increased from 21.1 % in 2005 to 30.9 % in 2010 (p < 0.01), while the percentage with a Charlson score over 2 more than doubled (1.2-2.7 %; p < 0.01). Inpatient complication rates (6.3 vs. 6.6 %; p = 0.21) and mortality (0.08 vs. 0.21; p = 0.72) were unchanged. On multivariate analysis, patients older than 79 years were three times as likely to develop a complication (odds ratio [OR] 3.1; 95 % CI 2.1-4.5) as were patients with a Charlson score over 2 (OR 3.1; 95 % CI 2.2-4.3).
  
  
  CONCLUSIONS
  Today's antireflux surgery patient population is a higher-risk cohort, but complication rates have remained stable and inpatient mortality has declined more than 50 % over the past decade. Given these findings, additional research is needed to understand why antireflux surgery is underutilized, with a decline of more than two-thirds since its peak in 1999.
authors.affiliation: Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University Medical Center, Columbus, OH, USA, funk@surgery.wisc.edu.
authors.forename: Luke M
authors.initials: LM
authors.lastname: Funk
authors.forename: Aliyah
authors.initials: A
authors.lastname: Kanji
authors.forename: W
authors.initials: W
authors.lastname: Scott Melvin
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult