title: Comparative Analysis of Perioperative Outcomes and Costs Between Laparoscopic and Open Antireflux Surgery.
abstract: BACKGROUND
  Laparoscopic antireflux surgery (LARS) has proven to be as effective as open antireflux surgery (OARS), but it is associated with a shorter hospital stay and a faster recover. The aims of this study were to assess the national use of LARS in the US and to compare the perioperative outcomes between laparoscopic and open antireflux procedures in a national cohort.
  
  
  METHODS
  A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000 to 2013. The study included adult patients (18 years and older) diagnosed with gastroesophageal reflux disease (GERD), who underwent either laparoscopic or open fundoplication. Multivariable linear and logistic regression, adjusted for patient demographics, comorbidities, and hospital characteristics were used to assess the effect of the laparoscopic approach on patient outcomes.
  
  
  RESULTS
  A total of 75,544 patients were included, with 44,089 having LARS (58.4%) and 31,455 having OARS (41.6%). The rate of laparoscopic procedures increased from 24.8 LARS per 100 procedures in 2000, to 84.3 LARS per 100 procedures in 2013 (p < 0.0001). Patients undergoing laparoscopic surgery were less likely to experience postoperative venous thromboembolism, wound complications, infection, esophageal perforation, bleeding, cardiac failure, renal failure, respiratory failure, shock, and inpatient mortality. On average, the laparoscopic approach reduced length of stay by 2.1 days, and decreased hospital charges by $9,530.
  
  
  CONCLUSIONS
  The use of the laparoscopic approach for the surgical treatment of GERD has increased significantly in the last decade in the US. This approach is associated with lower morbidity and mortality, shorter hospital stay, and lower costs for the health care system.
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: fschlottmann@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Paula D
authors.initials: PD
authors.lastname: Strassle
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D000328:Adult; D005260:Female; D018662:Fundoplication / Q000191:economics* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States