Top

Surgical Endoscopy

Published in:

01-05-2013

Early outcomes of antireflux surgery for United States lung transplant recipients

Authors: Arman Kilic, Ashish S. Shah, Christian A. Merlo, Christine G. Gourin, Anne O. Lidor

Published in: Surgical Endoscopy | Issue 5/2013

Abstract

Background

This study aimed to evaluate early outcomes after antireflux surgery for lung transplant (LTx) recipients in the United States.

Methods

Adult patients undergoing elective antireflux surgery between 2003 and 2008 were identified in the Nationwide Inpatient Sample. A propensity-matched analysis compared early outcomes between prior LTx recipients and well-matched control subjects consisting of non-LTx patients undergoing elective antireflux surgery during the same era. The primary outcome was inpatient mortality, and the secondary outcomes were hospital length of stay (LOS), perioperative complications, and hospital costs.

Results

During the study period, 401 LTx recipients underwent elective antireflux surgery. These patients were well matched with 401 control patients in terms of age, sex, individual and overall comorbidity burden, hospital teaching status, hospital location, hospital antireflux volume, and open versus laparoscopic approach. The overall operative mortality rate was 1.4 %, with no difference between the groups. The overall and individual morbidity rates also were similar. The LOS and hospital costs were significantly greater in the LTx group. Multivariable logistic regression analysis confirmed that prior LTx did not confer an increased risk of inpatient mortality after antireflux surgery.

Conclusions

To date, this is the largest study to examine outcomes of antireflux surgery for LTx recipients. Operative mortality and morbidity appear to be comparable with those of the general population, although resource utilization is greater. Based on these data, trials to evaluate the role of antireflux surgery in preserving allograft function after LTx should not be hindered by a perceived notion of prohibitive operative risk in this patient population.

Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dobbels F, Kirk R, Rahmel AO, Stehlik J, Hertz MI (2011) The registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult lung and heart–lung transplant report—2011. J Heart Lung Transplant 30:1104–1122PubMedCrossRef

Heng D, Sharples LD, McNeil K, Stewart S, Wreghitt T, Wallwork J (1998) Bronchiolitis obliterans syndrome: incidence, natural history, prognosis, and risk factors. J Heart Lung Transplant 17:1255–1263PubMed

Valentine VG, Robbins RC, Berry GJ, Patel HR, Reichenspurner H, Reitz BA, Theodore J (1996) Actuarial survival of heart–lung and bilateral sequential lung transplant recipients with obliterative bronchiolitis. J Heart Lung Transplant 15:371–383PubMed

Davis RD Jr, Lau CL, Eubanks S, Messier RH, Hadjiliadis D, Steele MP, Palmer SM (2003) Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation. J Thorac Cardiovasc Surg 125:533–542PubMedCrossRef

Overview of the Nationwide Inpatient Sample (2012). http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 17 July 2012

Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17:864–867PubMedCrossRef

Hadjiliadis D, Duane Davis R, Steele MP, Messier RH, Lau CL, Eubanks SS, Palmer SM (2003) Gastroesophageal reflux disease in lung transplant recipients. Clin Transplant 17:363–368PubMedCrossRef

Button BM, Roberts S, Kotsimbos TC, Levvey BJ, Williams TJ, Bailey M, Snell GI, Wilson JW (2005) Gastroesophageal reflux (symptomatic and silent): a potentially significant problem in patients with cystic fibrosis before and after lung transplantation. J Heart Lung Transplant 24:1522–1529PubMedCrossRef

Sweet MP, Patti MG, Leard LE, Golden JA, Hays SR, Hoopes C, Theodore PR (2007) Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. J Thorac Cardiovasc Surg 133:1078–1084PubMedCrossRef

10.

Kempainen RR, Savik K, Whelan TP, Dunitz JM, Herrington CS, Billings JL (2007) High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD. Chest 131:1666–1671PubMedCrossRef

11.

Berkowitz N, Schulman LL, McGregor C, Markowitz D (1995) Gastroparesis after lung transplantation: potential role in postoperative respiratory complications. Chest 108:1602–1607PubMedCrossRef

12.

Young LR, Hadjiliadis D, Davis RD, Palmer SM (2003) Lung transplantation exacerbates gastroesophageal reflux disease. Chest 124:1689–1693PubMedCrossRef

13.

Duarte AG, Terminella L, Smith JT, Myers AC, Campbell G, Lick S (2008) Restoration of cough reflex in lung transplant recipients. Chest 134:310–316PubMedCrossRef

14.

King BJ, Iyer H, Leidi AA, Carby MR (2009) Gastroesophageal reflux in bronchiolitis obliterans syndrome: a new perspective. J Heart Lung Transplant 28:870–875PubMedCrossRef

15.

Parada MT, Alba A, Sepulveda C (2010) Bronchiolitis obliterans syndrome development in lung transplantation patients. Transplant Proc 42:331–332PubMedCrossRef

16.

Hoppo T, Jarido V, Pennathur A, Morrell M, Crespo M, Shigemura N, Bermudez C, Hunter JG, Toyoda Y, Pilewski J, Luketich JD, Jobe BA (2011) Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg 146:1041–1047PubMedCrossRef

17.

Hartwig MG, Anderson DJ, Onaitis MW, Reddy S, Snyder LD, Lin SS, Davis RD (2011) Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux. Ann Thorac Surg 92:462–468PubMedCrossRef

18.

Murthy SC, Nowicki ER, Mason DP, Budev MM, Nunez AI, Thuita L, Chapman JT, McCurry KR, Pettersson GB, Blackstone EH (2011) Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation. J Thorac Cardiovasc Surg 142:47–52PubMedCrossRef

19.

Burton PR, Button B, Brown W, Lee M, Roberts S, Hassen S, Bailey M, Smith A, Snell G (2009) Medium-term outcome of fundoplication after lung transplantation. Dis Esophagus 22:642–648PubMedCrossRef

20.

Brehant O, Pessaux P, Arnaud JP, Delattre JF, Meyer C, Baulieux J, Mosnier H (2006) Long-term outcome of laparoscopic antireflux surgery in the elderly. J Gastrointest Surg 10:439–444PubMedCrossRef

21.

Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB (2004) Evidence-based appraisal of antireflux fundoplication. Ann Surg 239:325–337PubMedCrossRef

22.

Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, Arndorfer J, Christensen L, Merion RM (2003) Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 349:931–940PubMedCrossRef

23.

Fisichella PM, Davis CS, Gagermeier J, Dilling D, Alex CG, Dorfmeister JA, Kovacs EJ, Love RB, Gamelli RL (2011) Laparoscopic antireflux surgery for gastroesophageal reflux disease after lung transplantation. J Surg Res 170:e279–e286PubMedCrossRef

24.

Klabunde CN, Warren JL, Legler JM (2002) Assessing comorbidity using claims data: an overview. Med Care 40:26–35CrossRef

Title: Early outcomes of antireflux surgery for United States lung transplant recipients
Authors: Arman Kilic
Ashish S. Shah
Christian A. Merlo
Christine G. Gourin
Anne O. Lidor
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2674-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early outcomes of antireflux surgery for United States lung transplant recipients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2013

Perioperative risk factors for 30-day mortality after bariatric surgery: is functional status important?

Long-term follow-up study of gallbladder in situ after endoscopic common duct stone removal in Korean patients

Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach

It is feasible to operate on pathological Masaoka stage I and II thymoma patients with video-assisted thoracoscopy: analysis of factors for a successful resection

Laparoscopic bisegmentectomy 6 and 7 using a Glissonian approach and a half-Pringle maneuver

Single-incision laparoscopic colectomy: training the next generation