Background:
In North America, the prevalence of gastro-esophageal reflux disorder ranges from 18.1% to 27.8%. We measured the risk posed by preoperative esophageal disease for patients undergoing abdominal operations.
Method:
2005–2015 ACS NSQIP data were merged with institutional Clinical Data Repository records to identify esophageal disease in surgical patients undergoing intra-abdominal procedures. Patients with esophageal disease were classified as gastro-esophageal reflux (GERD) or Other, which included patients with esophageal stricture, spasm, ulcer, or diverticuli, achalasia, esophagitis, reflux esophagitis, Barrett’s esophagus, and multiple esophageal diagnoses, excluding GERD. ACS NSQIP targeted procedures groups included were colectomy, proctectomy, ventral hernia repair, bariatric surgery, hepatectomy, appendectomy, abdominal aortic aneurysm repair, open aortoiliac repair, hysterectomy, myomectomy, and oophorectomy. Multivariable logistic regression was used to model postoperative complication rates, adjusting for ACS NSQIP risk of morbidity, demographic factors, ACS NSQIP targeted procedure groups, and open versus laparoscopic surgery.
Results:
Of 9,172 intra-abdominal cases, 21.3% had preoperative esophageal disease (19.6% GERD and 1.7% Other). After adjustment, patients with GERD were at higher risk for experiencing a number of complications, including all-cause 30-day complication (OR= 1.21, 95% CI 1.05–1.41, p = 0.044), renal complication (OR= 1.43 , 95% CI 1.09–1.87, p= 0.036), wound complication (OR= 1.40, 95% CI 1.10 – 1.79, p= 0.028), and readmission within 30 days (OR= 1.66, 95% CI 1.35–2.04, p <0.001).
Conclusion:
Preoperative GERD is associated with increased postoperative complication rate. Surgeons should consider assessing GERD in patients undergoing abdominal operations.