Flum David R, Koepsell Thomas, Heagerty Patrick, Pellegrini Carlos A
Department of Surgery, University of Washington, Seattle 98195-7183, USA.
J Am Coll Surg. 2002 Nov;195(5):611-8. doi: 10.1016/s1072-7515(02)01490-4.
The population level frequency of adverse events after antireflux procedures and its relationship to surgical experience has not been well studied.
Two parallel retrospective, population-based cohort studies were conducted using 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 frequency of case fatality, splenectomy, and esophageal injury was measured. In Washington State, the relationship of adverse outcomes to the cumulative number of procedures performed by a given surgeon (case-order) was determined.
Nationwide, an estimated 86,411 patients underwent antireflux surgery between 1992 and 1997. Splenectomy was performed in 2.3%, suture of esophageal laceration in 1.1%, and in-hospital death occurred in 0.8%. Adverse events were significantly more likely when procedures at case-order less than or equal to 15 (median) were compared with those at case-order greater than 15. As case-order increased by 1, the risk of death decreased by 1.7% (p = 0.001), and the risk of splenectomy and injury repair decreased by 1.6% (p = 0.001). If performed at case-order less than 15, the odds ofsplenectomy 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.
On a national level, morbidity and mortality associated with antireflux surgery performed in the 1 990s was quite low, but was somewhat higher than suggested by case series. Surgical experience with the procedure was linked to better outcomes.
抗反流手术后不良事件的人群发生率及其与手术经验的关系尚未得到充分研究。
使用华盛顿州出院数据库和美国医疗保健利用项目（HCUP）数据库进行了两项平行的基于人群的回顾性队列研究。纳入了1992年至1997年期间被分配抗反流手术ICD-9手术编码的所有成年患者。测量了病死率、脾切除术和食管损伤的发生率。在华盛顿州，确定了不良结局与特定外科医生所进行手术的累积数量（病例顺序）之间的关系。
在全国范围内，1992年至1997年期间估计有86411例患者接受了抗反流手术。脾切除术的实施率为2.3%，食管裂伤缝合术的实施率为1.1%，住院死亡率为0.8%。当将病例顺序小于或等于15（中位数）的手术与病例顺序大于15的手术进行比较时，不良事件的发生可能性显著更高。随着病例顺序增加1，死亡风险降低1.7%（p = 0.001），脾切除术和损伤修复风险降低1.6%（p = 0.001）。如果在病例顺序小于15时进行手术，脾切除术的几率是病例顺序较晚时进行手术不良结局几率的2.7倍，食管裂伤修复的几率是2.3倍，死亡的几率是5.6倍。
在国家层面，20世纪90年代进行的抗反流手术相关的发病率和死亡率相当低，但略高于病例系列研究的结果。该手术的经验与更好的结局相关。
