Nationwide Inpatient Sample: Have Antireflux Procedures Undergone Regionalization?

Excerpt

The Nissen fundoplication was introduced in 1956 by Rudolph Nissen1 and is a proven, effective treatment for gastroesophageal reflux disease (GERD).2 The laparoscopic technique was first described in 1991 by Bernard Dallemagne3 and has also been shown to be safe and effective in treatment of GERD.4 From 1990 to 1997, antireflux surgery rates almost tripled5 and peaked in 1999,6 which was followed by a steady decline through 2006.7 The decline in surgical volume has been partially attributed to a question of the long-term effectiveness of antireflux surgery, where re-operation can often become required, and many patients require acid suppression medications post-operatively.8 ^– 11 The decline of operative intervention has also been attributed to the availability of over-the-counter proton pump inhibitors, new endoscopic therapies for treating GERD, and the rise of bariatric surgery.6, 7 Increasing outpatient antireflux procedures has also been examined as a potential cause for the decrease of inpatient cases. However, analysis of outpatient data in several states has revealed that the decrease in inpatient procedures in not nearly matched by the volume of outpatient procedures.7 …