University of Oulu

Manar Yanes, Giola Santoni, John Maret-Ouda, Sheraz Markar, Eivind Ness-Jensen, Joonas Kauppila, Martti Färkkilä, Elsebeth Lynge, Eero Pukkala, Laufey Tryggvadóttir, My von Euler-Chelpin, Jesper Lagergren, Mortality, Reoperation, and Hospital Stay Within 90 Days of Primary and Secondary Antireflux Surgery in a Population-Based Multinational Study, Gastroenterology, Volume 160, Issue 7, 2021, Pages 2283-2290, ISSN 0016-5085,

Mortality, reoperation, and hospital stay within 90 days of primary and secondary antireflux surgery in a population-based multinational study

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Author: Yanes, Manar1; Santoni, Giola1; Maret-Ouda, John1,2;
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
2Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
3Department of Surgery and Cancer, Imperial College London, London, United Kingdom
4Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim/Levanger, Norway
5Medical Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
6Surgery Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
7Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
8Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
9Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
10Faculty of Social Sciences, Tampere University, Tampere, Finland
11Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
12Faculty of Medicine, University of Iceland, Reykjavik, Iceland
13Department of Public Health, University of Copenhagen, Copenhagen, Denmark
14School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Elsevier, 2021
Publish Date: 2022-01-18


Background & Aims: Absolute rates and risk factors of short-term outcomes after antireflux surgery remain largely unknown. We aimed to clarify absolute risks and risk factors for poor 90-day outcomes of primary laparoscopic and secondary antireflux surgery.

Methods: This population-based cohort study included patients who had primary laparoscopic or secondary antireflux surgery in the 5 Nordic countries in 2000–2018. In addition to absolute rates, we analyzed age, sex, comorbidity, hospital volume, and calendar period in relation to all-cause 90-day mortality (main outcome), 90-day reoperation, and prolonged hospital stay (≥2 days over median stay). Multivariable logistic regression provided odds ratios (ORs) with 95% confidence intervals (95% CI), adjusted for confounders.

Results: Among 26,193 patients who underwent primary laparoscopic antireflux surgery, postoperative 90-day mortality and 90-day reoperation rates were 0.13% (n = 35) and 3.0% (n = 750), respectively. The corresponding rates after secondary antireflux surgery (n = 1 618) were 0.19% (n = 3) and 6.2% (n = 94). Higher age (56–80 years vs 18–42 years: OR, 2.66; 95% CI 1.03-6.85) and comorbidity (Charlson Comorbidity Index ≥2 vs 0: OR, 6.25; 95% CI 2.42-16.14) increased risk of 90-day mortality after primary surgery, and higher hospital volume suggested a decreased risk (highest vs lowest tertile: OR, 0.58; 95% CI, 0.22-1.57). Comorbidity increased the risk of 90-day reoperation. Higher age and comorbidity increased risk of prolonged hospital stay after both primary and secondary surgery. Higher annual hospital volume decreased the risk of prolonged hospital stay after primary surgery (highest vs lowest tertile: OR, 0.74; 95% CI, 0.67-0.80).

Conclusion: These findings suggest that laparoscopic antireflux surgery has an overall favorable safety profile in the treatment of gastroesophageal reflux disease, particularly in younger patients without severe comorbidity who undergo surgery at high-volume centers.

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Series: Gastroenterology
ISSN: 0016-5085
ISSN-E: 1528-0012
ISSN-L: 0016-5085
Volume: 160
Issue: 7
Pages: 2283 - 2290
DOI: 10.1053/j.gastro.2021.02.022
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
Copyright information: © 2021 by the AGA Institute. Published by Elsevier Inc. This is an open access article under the CC BY license (