The rise and fall of antireflux surgery in the United States
The rise and fall of antireflux surgery in the United States
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DOI：
10.1007/s00464-006-0042-3
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发表时间：
2006-11-01
影响因子：
3.1
通讯作者：
Birkmeyer, John D.
中科院分区：
文献类型：
--
作者：
Finks, Jonathan F.;Wei, Yongliang;Birkmeyer, John D.
背景：20世纪90年代，全国腹腔镜抗反流手术率稳步增长。从那时起，一项高度可见的随机试验对抗反流手术的长期有效性提出了质疑，一些新的内窥镜疗法已经开发出来，质子泵抑制剂已经成为非处方药物。这些最近的发展是否对抗反流手术的使用产生了影响尚不清楚。方法：使用来自全国住院患者样本的数据，本研究确定了1994年至2003年间接受抗反流手术的所有18岁以上患者。抽样权重用于估计每年在美国进行的手术总数。基于人口的比率是使用美国人口普查数据的分母来确定的。结果：该研究证实了早期研究的结果，发现抗反流手术的年数量在20世纪90年代迅速增长，1999年达到31,695例（每10万成年人15.7例）的峰值。1999年后，手术率稳步下降，到2003年下降了约30%，达到23,998例（每100,000例11例；p < 0.0001）。年轻患者（30- 49岁为39%，60岁以上为12.5%,p < 0.0001）和教学医院（36%，非教学医院为23%，p < 0.0001）的抗反流手术使用率下降更为急剧。1999年以后腹腔镜手术的比例保持稳定。结论：在美国，抗反流手术的使用已经大幅下降。尽管可能涉及其他因素，但这一趋势可能反映了关于手术长期有效性的新问题，并提示需要进行前瞻性随机临床试验来评估当前的治疗方法。
Background: National rates of laparoscopic antireflux surgery grew steadily in the 1990s. Since then, a highly visible randomized trial has questioned the long-term effectiveness of antireflux surgery, several new endoscopic therapies have been developed, and proton pump inhibitors have become available over the counter. Whether these recent developments have had an impact on the use of antireflux surgery remains unknown.Methods: Using data from the Nationwide Inpatient Sample, this study identified all patients older than 18 years who underwent antireflux surgery between 1994 and 2003. Sampling weights were used to estimate the total number of procedures performed in the United States each year. Population-based rates were determined using denominators from U.S. census data.Results: Confirming the results of earlier studies, this study found that the annual number of antireflux procedures grew rapidly during the 1990s, peaking at 31,695 (15.7 cases per 100,000 adults) in 1999. After 1999, surgical rates declined steadily, falling approximately 30% by 2003 to 23,998 (11 cases per 100,000; p < 0.0001). Use of antireflux procedures fell more precipitously among younger patients (39% for 30- to 49-year-olds vs 12.5% for those older than 60 years; p < 0.0001) and at teaching hospitals (36% vs 23% at nonteaching hospitals; p < 0.0001). The proportion of cases managed laparoscopically remained stable after 1999.Conclusions: The use of antireflux surgery in the United States has declined substantially. Although other factors may be involved, this trend may reflect new questions about the long-term effectiveness of surgery and suggests the need for prospective randomized clinical trials assessing current therapies.