| アブストラクト | BACKGROUND: After antireflux surgery, highly variable rates of recurrent gastroesophageal reflux disease (GERD) have been reported. OBJECTIVE: To identify the occurrence and risk factors of recurrent GERD requiring surgical reintervention or medication. METHODS: The Hospital Episode Statistics database was used to identify adults in England receiving primary antireflux surgery for GERD in 2000 to 2012 with follow-up through 2014, and the outcome was surgical reintervention. In a subset of participants, the Clinical Practice Research Datalink was additionally used to assess proton pump inhibitor therapy for at least 6 months (medical reintervention). Risk factors were assessed using multivariable Cox regression providing adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). RESULTS: Among 22,377 patients who underwent primary antireflux surgery in the Hospital Episode Statistics dataset, 811 (3.6%) had surgical reintervention, with risk factors being age 41 to 60 years (HR = 1.22, 95% CI 1.03-1.44), female sex (HR = 1.5; 95% CI 1.3-1.74), white ethnicity (HR = 1.71, 95% CI 1.06-2.77), and low hospital annual volume of antireflux surgery (HR = 1.32, 95% CI 1.04-1.67). Among 2005 patients who underwent primary antireflux surgery in the Clinical Practice Research Datalink dataset, 189 (9.4%) had surgical reintervention and 1192 (59.5%) used proton pump inhibitor therapy, with risk factors for the combined outcome being age >60 years (HR = 2.38, 95% CI 1.81-3.13) and preoperative psychiatric morbidity (HR = 1.58, 95% CI 1.25-1.99). CONCLUSION: At least 3.6% of patients may require surgical reintervention and 59.5% medical therapy following antireflux surgery in England. The influence of patient characteristics and hospital volume highlights the need for patient selection and surgical experience in successful antireflux surgery. |
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| ジャーナル名 | Annals of surgery |
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| 投稿日 | 2018/12/1 |
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| 投稿者 | Markar, Sheraz R; Arhi, Chanpreet; Wiggins, Tom; Vidal-Diez, Alberto; Karthikesalingam, Alan; Darzi, Ara; Lagergren, Jesper; Hanna, George B |
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| 組織名 | Department of Surgery and Cancer, Imperial College London, London, UK.;Molecular and Clinical Sciences Institute, St George's University of London,;Cranmer Terrace, London, UK.;School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.;Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm,;Sweden. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30499807/ |
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