Achalasia is a rare chronic disorder of esophageal motor function.
Single-center reports suggest that there has been greater use of laparoscopic Heller myotomy for achalasia in the United States since its introduction in 1992.
Dr Richard Wang and colleagues from the USA assessed the trends of Heller myotomy and the relationship between surgery volume and perioperative outcomes.
The team used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a 20% stratified sample of all hospitalizations in the United States.
|1% had the diagnosis of esophageal perforation at discharge|
|American Journal of Gastroenterology|
It was used to study the macro-trends of Heller myotomy hospitalizations during 1993 and 2005.
The team also used the Nationwide Inpatient Sample between 2003 and 2005 micro-data to study the perioperative outcomes of Heller myotomy hospitalizations.
The researchers evaluated other achalasia and laparoscopic cholecystectomy hospitalizations as control groups.
The generalized linear model with repeated observations from the same unit was used to adjust for multiple hospitalizations from the same hospital.
The researchers found that the national estimate of Heller myotomy hospitalizations increased from 728 to 2255 during 1993 and 2005.
The mean length of stay decreased from 10 to 4 days.
Of the 1117 Heller myotomy hospitalizations in the Nationwide Inpatient Sample from 2003 to 2005, 1% had the diagnosis of esophageal perforation at discharge.
Length of stay was negatively correlated with a hospital's number of Heller myotomy per year.
In multivariate log-linear regressions with a control group, a hospital's number of Heller myotomy per year was negatively associated with length of stay and total charges.
These findings were robust in alternative statistical models, specifications, and subgroup analyses.
Dr Wang’s team concluded, “On a national level, the introduction of laparoscopic Heller myotomy for achalasia was associated with greater use of surgery and shorter length of stay.”
“A larger volume of Heller myotomy in a hospital was associated with better perioperative outcomes in terms of shorter length of stay and lower total charges.”