The frequency of adverse events after antireflux procedures and relationship to surgical experience has not been well studied.
Researchers from the United States conducted 2 parallel retrospective, population-based cohort studies.
They utilized the Washington State discharge database and the United States Health Care Utilization Project (HCUP) database.
All adult patients assigned ICD-9 procedure codes for antireflux surgery from 1992 to 1997 were included.
The team measured the frequency of case fatality, splenectomy, and esophageal injury.
|Adverse events significantly more likely when case-order is ≤ 15.|
|Journal of the American College of Surgeons|
In Washington State, the team also determined the relationship of adverse outcomes to the cumulative number of procedures performed by a given surgeon (case-order).
The research team found that nationwide, an estimated 86,411 patients underwent antireflux surgery between 1992 and 1997.
Of these, splenectomy was performed in 2.3%, suture of esophageal laceration in 1.1%, and in-hospital death occurred in 0.8%.
The team determined that adverse events were significantly more likely when procedures at case-order ≤ 15 were compared with those at case-order > 15.
Furthermore, as case-order increased by 1, the risk of death decreased by 1.7%, and the risk of splenectomy and injury repair decreased by 1.6%.
Dr David Flum's team stated that, "If performed at case-order < 15, the odds of splenectomy were 2.7 times, esophageal laceration repair 2.3 times, and death 5.6 times greater than the odds of adverse outcomes for procedures performed at later case-orders".