title: Charges, outcomes, and complications: a comparison of magnetic sphincter augmentation versus laparoscopic Nissen fundoplication for the treatment of GERD.
abstract: Magnetic sphincter augmentation (MSA) is approved for uncomplicated GERD. Multiple studies have shown MSA to compare favorably to laparoscopic Nissen fundoplication (LNF) in terms of symptom control with results out to 5 years. The MSA device itself, however, is an added cost to an anti-reflux surgery, and direct cost comparison studies have not been done between MSA and LNF. The aim of the study was to compare charges, complications, and outcome of MSA versus LNF at 1 year.
  
  
  
  This is a retrospective analysis of all patients who underwent MSA or LNF for the treatment of GERD between January 2010 and June 2013. Patient charges were collected for the surgical admission. We also collected data on 30-day complications and symptom control at 1 year assessed by GERD-HRQL score and PPI use.
  
  
  
  There were 119 patients included in the study, 52 MSA and 67 LNF. There was no significant difference between the mean charges for MSA and LNF ($48,491 vs. $50,111, p = 0.506). There were significant differences in OR time (66 min MSA vs. 82 min LNF, p < 0.01) and LOS (17 h MSA vs. 38 h LNF, p < 0.01). At 1-year follow-up, mean GERD-HRQL was 4.3 for MSA versus 5.1 for LNF (p = 0.47) and 85 % of MSA patients versus 92 % of LNF patients were free from PPIs (p = 0.37). MSA patients reported less gas bloat symptoms (23 vs. 53 %, p ≤ 0.01) and inability to belch (10 vs. 36 %, p ≤ 0.01) and vomit (4 vs. 19 %, p ≤ 0.01).
  
  
  
  The side effect profile of MSA is better than LNF as evidenced by less gas bloat and increase ability to belch and vomit. LNF and MSA are comparable in symptom control, safety, and overall hospital charges. The charge for the MSA device is offset by less charges in other categories as a result of the shorter operative time and LOS.
authors.affiliation: Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Reynolds
authors.affiliation: Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehetner
authors.affiliation: Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Nieh
authors.affiliation: Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Bildzukewicz
authors.affiliation: Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Kulmeet
authors.initials: K
authors.lastname: Sandhu
authors.affiliation: Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Namir
authors.initials: N
authors.lastname: Katkhouda
authors.affiliation: Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA. john.lipham@med.usc.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Lipham
mesh_terms: D003365:Costs and Cost Analysis; D003680:Deglutition Disorders / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000191:economics; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005414:Flatulence / Q000453:epidemiology; D018662:Fundoplication / Q000191:economics*; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery*; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D059346:Magnets; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D054328:Proton Pump Inhibitors
keywords: Charges; Fundoplication; Gastroesophageal reflux disease; Magnetic sphincter augmentation