title: Univariate and multivariate analyses of preoperative factors influencing symptomatic outcomes of transoral fundoplication.
abstract: BACKGROUND
  Preoperative factors predicting symptomatic improvement after transoral fundoplication (TF) in chronic gastroesophageal reflux disease (GERD) patients with persistent symptoms on proton-pump inhibitors (PPIs) therapy have not been elucidated fully.
  
  
  METHODS
  Univariate and multivariate logistic regression analyses were performed on data from 158 consecutive patients who underwent TF with the EsophyX device between January 2010 and June 2012 in 14 community centers. Variables included age, gender, body mass index, GERD duration, PPIs therapy duration, presence of hiatal hernia, esophagitis, Hill grade, quality of life scores (QOL) on PPIs, % total time pH < 4, and DeMeester score on reflux testing off PPIs.
  
  
  RESULTS
  All patients suffered from typical GERD symptoms. Additionally, 78% (124/158) of patients suffered from atypical symptoms. Six percent (10/158) with recurrent GERD symptoms refractory to PPI therapy underwent revisional procedure (9 laparoscopic Nissen, 1 TF). Median follow-up was 22 (range 10-43) months. For patients with typical symptoms, univariate analyses revealed 4 preoperative factors predictive of successful outcomes: age ≥ 50 [odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.2-4.8, p = 0.014], GERD Health-related Quality of Life score (GERD-HRQL) ≥ 15 on PPIs (OR = 6.0, CI = 1.2-29.4, p = 0.026, Reflux Symptom Index score > 13 on PPIs (OR = 2.4, CI = 1.1-5.2, p = 0.027), and Gastroesophageal Reflux Symptom Score ≥ 18 on PPIs (OR = 2.6, CI = 1.2-5.8, p = 0.018). Age and GERD-HRQL score remained significant predictors by multivariate analysis. For patients with atypical symptoms, only GERD-HRQL score ≥ 15 on PPIs (OR = 9.9, CI = 0.9-4.6, p = 0.036) was associated with successful outcomes.
  
  
  CONCLUSIONS
  Elevated preoperative QOL scores on PPIs and age ≥ 50 were most closely associated with successful outcome of TF in patients with persistent symptoms despite medical therapy.
authors.affiliation: SurgOne Foregut Institute, 401 West Hampden Place, Suite 230, Englewood, CO, 80110, USA, rbell@surgone.com.
authors.forename: Reginald C W
authors.initials: RC
authors.lastname: Bell
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fox
authors.forename: William E
authors.initials: WE
authors.lastname: Barnes
authors.forename: Peter G
authors.initials: PG
authors.lastname: Mavrelis
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sewell
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Carter
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Ihde
authors.forename: Karim S
authors.initials: KS
authors.lastname: Trad
authors.forename: David
authors.initials: D
authors.lastname: Dargis
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Hoddinott
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Freeman
authors.forename: Tanja
authors.initials: T
authors.lastname: Gunsberger
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hausmann
authors.forename: Brian DaCosta
authors.initials: BD
authors.lastname: Gill
authors.forename: Erik
authors.initials: E
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004941:Esophagitis / Q000150:complications; D004947:Esophagus / Q000293:injuries; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors