Original article
Complications and Antireflux Medication Use After Antireflux Surgery

https://doi.org/10.1016/j.cgh.2005.12.019Get rights and content

Background & Aims: Although antireflux surgery is increasingly common, few studies have assessed the associated complications and health care use after surgery. The aim of this study was to estimate postoperative complications and continued use of antireflux medications and to identify predictors of complications. Methods: Through a review of the Department of Veterans Affairs administrative databases, all patients undergoing antireflux surgery from October 1, 1990, through January 29, 2001, were identified. Of 3367 patients identified, 222 were excluded as a result of a diagnosis of esophageal cancer, achalasia, or because there was no diagnosis related to gastroesophageal reflux disease. Medication use was determined for 2406 patients who had a minimum of 1 year of follow-up, including 1 or more outpatient visits at least 6 months after surgery and during the time when national pharmacy records were available. Results: Dysphagia was recorded in 19.4%, dilation was performed in 6.4%, and a repeat antireflux surgery was performed in 2.3%. The surgical mortality rate was .8%. Prescriptions were dispensed repeatedly for H2 receptor antagonists in 23.8%, proton pump inhibitors in 34.3%, and promotility agents in 9.2% of patients. Overall, 49.8% of patients received at least 3 prescriptions for one of these medications. Conclusions: A moderate proportion of patients undergoing antireflux surgeries experienced complications and approximately 50% of patients received multiple prescriptions for antireflux medications at a median of 5 years of follow-up evaluation. Therefore, before surgery is performed, patients considering surgery should be counseled fully about the risk for complications and the likelihood of continued antireflux medication use.

Section snippets

Database

We obtained all data from the VA national Patient Treatment File (PTF), outpatient clinic file, National VA Pharmacy Database, and the Beneficiary Identification and Record Locator System for October 1, 1990, through February 28, 2001. The PTF contains diagnosis codes for all admissions at any VA medical center nationwide. For each discharge, up to 10 diagnoses, 5 operating room procedures, and 32 non–operating room procedures are listed according to the International Classification of

Complications After Fundoplication Surgery

Among the 3145 patients in the overall cohort, the median follow-up period was 4.5 years (range, 0–10.4 y). Table 1 shows patient demographics. Overall, 368 (11.7%) patients died during the study period. The proportions of patients reported to have dysphagia, dilations, redo-fundoplication, and surgical mortality and the timing of these complications are shown in Table 2. By using Cox models, increasing age was associated with an increased risk for having a diagnosis of dysphagia, undergoing

Discussion

Our results indicate that antireflux surgery in the VA medical system is associated with moderate rates of complications and substantial rates of antireflux medication use after a median of approximately 5 years of follow-up. Although there is a pattern of decreased use of these medications in the 3 to 6 months after surgery, approximately 50% of patients are receiving multiple antireflux prescriptions at a median of almost 5 years. Fortunately, significant complications (ie, mortality,

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    Supported by a grant from the American College of Gastroenterology.

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    Copyright © 2006 American Gastroenterological Association Institute. Published by Elsevier Ltd. All rights reserved.