A comparison of pre-operative comorbidities and post-operative outcomes among XXXX undergoing laparoscopic nissen fundoplication at high- and low-volume centers.

@entity1 @entity1318 @entity407 @entity6 @entity11035 @entity891 @entity418 @entity354 @entity1030 @entity258 @entity1577
INTRODUCTION: Commonly cited data promoting @entity11035 ( @entity11035 ) as safe and efficacious are typically published by single centers, affiliated with teaching institutions with a high volume of cases, but @entity11035 is not universally performed at these hospitals. The purpose of this study is to assess where these procedures are being done and to compare pre-operative comorbidities and post-operative outcomes between high-and low-volume centers using a state-wide inpatient database. METHODS: This is a retrospective study using data from the North Carolina Hospital Association @entity1 Data System. Selected @entity1 include adults (>17  years old) that have undergone @entity11035 for @entity354 as an inpatient from 2005 to 2008. @entity1 that underwent operative management for emergent purposes or had associated diagnoses of @entity418 or @entity1318 were excluded from the study. High-volume centers were defined as institutions that performed ten or more LNFs per year averaged over a period of 4  years. Comparative statistics were performed on comorbidities and complications between high- and low-volume centers. RESULTS: A total of 1,019 @entity1 underwent @entity11035 for @entity354 in North Carolina between 2005 and 2008 in the inpatient setting. High-volume centers performed 530 LNFs (52%) while low-volume centers performed 489 LNFs (48%). @entity1 at high-volume centers were older (median 52.5  years old vs. 49.0  years old, p   =   0.019), had a higher incidence of @entity6 (13.4% vs. 8.8%, p   =   0.026), @entity1030 (5.1% vs. 2.0 %, p   =   0.015), @entity407 (9.6% vs. 4.7%, p   =   0.004), and @entity1577 (2.8% vs. 0.8%, p   =   0.03). @entity1 with a history of transplantation were also more likely to undergo @entity11035 at a high-volume center (15.8% vs. 1.6%, p   <   0.0001). There were no deaths among the two groups and also no difference between median length of stay (2.7  days for high-volume center vs. 2.6  days for low-volume center). @entity258 had a higher incidence of intraoperative accidental puncture or laceration (3.3% vs. 0.9%, p   =   0.017) while high-volume centers had a higher incidence of @entity891 (5.3% vs. 2.5%, p   =   0.031). CONCLUSION: A significant proportion of the LNFs in North Carolina are performed at low-volume centers. High-volume centers perform @entity11035 on older @entity1 with more comorbidities. @entity258 have three times more accidental perforations, yet there is no detectable difference in mortality or median length of stay. It is impossible to tell if these perforations are managed at these low-volume centers or transferred to facilities with a higher level of care. These findings argue for regionalization of @entity11035 and for a reevaluation of the global safety of this operation.
