Schlottmann Francisco, Strassle Paula D, Patti Marco G
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.
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.
J Am Coll Surg. 2017 Mar;224(3):327-333. doi: 10.1016/j.jamcollsurg.2016.12.010. Epub 2017 Jan 26.
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.
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.
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.
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.
腹腔镜抗反流手术（LARS）已被证明与开放抗反流手术（OARS）同样有效，但住院时间更短且恢复更快。本研究的目的是评估美国LARS的全国使用情况，并比较全国队列中腹腔镜和开放抗反流手术的围手术期结果。
使用2000年至2013年的全国住院患者样本进行基于人群的回顾性分析。该研究纳入了诊断为胃食管反流病（GERD）的成年患者（18岁及以上），他们接受了腹腔镜或开放胃底折叠术。使用多变量线性和逻辑回归，并对患者人口统计学、合并症和医院特征进行调整，以评估腹腔镜手术方式对患者结局的影响。
共纳入75544例患者，其中44089例接受LARS（58.4%），31455例接受OARS（41.6%）。腹腔镜手术率从2000年每100例手术中的24.8例LARS增加到2013年每100例手术中的84.3例LARS（p < 0.0001）。接受腹腔镜手术的患者术后发生静脉血栓栓塞、伤口并发症、感染、食管穿孔、出血、心力衰竭、肾衰竭、呼吸衰竭、休克和住院死亡率的可能性较小。平均而言，腹腔镜手术方式使住院时间缩短2.1天，并使医院费用降低9530美元。
在美国，过去十年中腹腔镜手术方式用于GERD手术治疗的情况显著增加。这种手术方式与较低的发病率和死亡率、较短的住院时间以及医疗保健系统的较低成本相关。
