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Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease in England

Markar, Sheraz R. PhD*; Arhi, Chanpreet MRCS*; Wiggins, Tom PhD*; Vidal-Diez, Alberto PhD*,†; Karthikesalingam, Alan PhD; Darzi, Ara FRS*; Lagergren, Jesper PhD‡,§; Hanna, George B. PhD*

doi: 10.1097/SLA.0000000000003131
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Background: After antireflux surgery, highly variable rates of recurrent gastroesophageal reflux disease (GERD) have been reported.

Objective: To identify the occurrence and risk factors of recurrent GERD requiring surgical reintervention or medication.

Methods: The Hospital Episode Statistics database was used to identify adults in England receiving primary antireflux surgery for GERD in 2000 to 2012 with follow-up through 2014, and the outcome was surgical reintervention. In a subset of participants, the Clinical Practice Research Datalink was additionally used to assess proton pump inhibitor therapy for at least 6 months (medical reintervention). Risk factors were assessed using multivariable Cox regression providing adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs).

Results: Among 22,377 patients who underwent primary antireflux surgery in the Hospital Episode Statistics dataset, 811 (3.6%) had surgical reintervention, with risk factors being age 41 to 60 years (HR = 1.22, 95% CI 1.03–1.44), female sex (HR = 1.5; 95% CI 1.3–1.74), white ethnicity (HR = 1.71, 95% CI 1.06–2.77), and low hospital annual volume of antireflux surgery (HR = 1.32, 95% CI 1.04–1.67). Among 2005 patients who underwent primary antireflux surgery in the Clinical Practice Research Datalink dataset, 189 (9.4%) had surgical reintervention and 1192 (59.5%) used proton pump inhibitor therapy, with risk factors for the combined outcome being age >60 years (HR = 2.38, 95% CI 1.81–3.13) and preoperative psychiatric morbidity (HR = 1.58, 95% CI 1.25–1.99).

Conclusion: At least 3.6% of patients may require surgical reintervention and 59.5% medical therapy following antireflux surgery in England. The influence of patient characteristics and hospital volume highlights the need for patient selection and surgical experience in successful antireflux surgery.

*Department of Surgery and Cancer, Imperial College London, London, UK

Molecular and Clinical Sciences Institute, St George's University of London, Cranmer Terrace, London, UK

School of Cancer and Pharmaceutical Sciences, King's College London, London, UK

§Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Reprints: George B. Hanna, PhD, Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, South Wharf Road, London W2 1NY, UK. E-mail: g.hanna@imperial.ac.uk.

SRM is funded by the National Institute of Health Research. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute of Health Research, or the Department of Health. The United European Gastroenterology Research Prize (JL).

The authors report no conflicts of interest.

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