Jessica L Reynolds1, Joerg Zehetner1, Angela Nieh1, Nikolai Bildzukewicz1, Kulmeet Sandhu1, Namir Katkhouda1, John C Lipham2. 1. Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA. 2. Department of Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA. john.lipham@med.usc.edu.
Abstract
BACKGROUND: Magnetic sphincter augmentation (MSA) is approved for uncomplicated GERD. Multiple studies have shown MSA to compare favorably to laparoscopic Nissen fundoplication (LNF) in terms of symptom control with results out to 5 years. The MSA device itself, however, is an added cost to an anti-reflux surgery, and direct cost comparison studies have not been done between MSA and LNF. The aim of the study was to compare charges, complications, and outcome of MSA versus LNF at 1 year. METHODS: This is a retrospective analysis of all patients who underwent MSA or LNF for the treatment of GERD between January 2010 and June 2013. Patient charges were collected for the surgical admission. We also collected data on 30-day complications and symptom control at 1 year assessed by GERD-HRQL score and PPI use. RESULTS: There were 119 patients included in the study, 52 MSA and 67 LNF. There was no significant difference between the mean charges for MSA and LNF ($48,491 vs. $50,111, p = 0.506). There were significant differences in OR time (66 min MSA vs. 82 min LNF, p < 0.01) and LOS (17 h MSA vs. 38 h LNF, p < 0.01). At 1-year follow-up, mean GERD-HRQL was 4.3 for MSA versus 5.1 for LNF (p = 0.47) and 85 % of MSA patients versus 92 % of LNF patients were free from PPIs (p = 0.37). MSA patients reported less gas bloat symptoms (23 vs. 53 %, p ≤ 0.01) and inability to belch (10 vs. 36 %, p ≤ 0.01) and vomit (4 vs. 19 %, p ≤ 0.01). CONCLUSION: The side effect profile of MSA is better than LNF as evidenced by less gas bloat and increase ability to belch and vomit. LNF and MSA are comparable in symptom control, safety, and overall hospital charges. The charge for the MSA device is offset by less charges in other categories as a result of the shorter operative time and LOS.
BACKGROUND: Magnetic sphincter augmentation (MSA) is approved for uncomplicated GERD. Multiple studies have shown MSA to compare favorably to laparoscopic Nissen fundoplication (LNF) in terms of symptom control with results out to 5 years. The MSA device itself, however, is an added cost to an anti-reflux surgery, and direct cost comparison studies have not been done between MSA and LNF. The aim of the study was to compare charges, complications, and outcome of MSA versus LNF at 1 year. METHODS: This is a retrospective analysis of all patients who underwent MSA or LNF for the treatment of GERD between January 2010 and June 2013. Patient charges were collected for the surgical admission. We also collected data on 30-day complications and symptom control at 1 year assessed by GERD-HRQL score and PPI use. RESULTS: There were 119 patients included in the study, 52 MSA and 67 LNF. There was no significant difference between the mean charges for MSA and LNF ($48,491 vs. $50,111, p = 0.506). There were significant differences in OR time (66 min MSA vs. 82 min LNF, p < 0.01) and LOS (17 h MSA vs. 38 h LNF, p < 0.01). At 1-year follow-up, mean GERD-HRQL was 4.3 for MSA versus 5.1 for LNF (p = 0.47) and 85 % of MSA patients versus 92 % of LNF patients were free from PPIs (p = 0.37). MSA patients reported less gas bloat symptoms (23 vs. 53 %, p ≤ 0.01) and inability to belch (10 vs. 36 %, p ≤ 0.01) and vomit (4 vs. 19 %, p ≤ 0.01). CONCLUSION: The side effect profile of MSA is better than LNF as evidenced by less gas bloat and increase ability to belch and vomit. LNF and MSA are comparable in symptom control, safety, and overall hospital charges. The charge for the MSA device is offset by less charges in other categories as a result of the shorter operative time and LOS.
Entities:
Keywords:
Charges; Fundoplication; Gastroesophageal reflux disease; Magnetic sphincter augmentation
Authors: Luigi Bonavina; Tom DeMeester; Paul Fockens; Daniel Dunn; Greta Saino; Davide Bona; John Lipham; Willem Bemelman; Robert A Ganz Journal: Ann Surg Date: 2010-11 Impact factor: 12.969
Authors: Jessica L Reynolds; Joerg Zehetner; Nikolai Bildzukewicz; Namir Katkhouda; Giovanni Dandekar; John C Lipham Journal: Am Surg Date: 2014-10 Impact factor: 0.688
Authors: A M Grant; C Boachie; S C Cotton; R Faria; L Bojke; D M Epstein; C R Ramsay; B Corbacho; M Sculpher; Z H Krukowski; R C Heading; M K Campbell Journal: Health Technol Assess Date: 2013-06 Impact factor: 4.014
Authors: Jessica L Reynolds; Joerg Zehetner; Phil Wu; Shawn Shah; Nikolai Bildzukewicz; John C Lipham Journal: J Am Coll Surg Date: 2015-03-05 Impact factor: 6.113
Authors: Ron Goeree; Rob Hopkins; John K Marshall; David Armstrong; Wendy J Ungar; Charles Goldsmith; Christopher Allen; Mehran Anvari Journal: Value Health Date: 2011 Mar-Apr Impact factor: 5.725
Authors: Brian E Louie; Alexander S Farivar; Dale Shultz; Christina Brennan; Eric Vallières; Ralph W Aye Journal: Ann Thorac Surg Date: 2014-06-21 Impact factor: 4.330
Authors: Martin Riegler; Sebastian F Schoppman; Luigi Bonavina; David Ashton; Thomas Horbach; Matthias Kemen Journal: Surg Endosc Date: 2014-08-30 Impact factor: 4.584
Authors: Kais A Rona; James M Tatum; Joerg Zehetner; Katrin Schwameis; Carol Chow; Kamran Samakar; Adrian Dobrowolsky; Caitlin C Houghton; Nikolai Bildzukewicz; John C Lipham Journal: Surg Endosc Date: 2018-01-16 Impact factor: 4.584
Authors: Katrin Schwameis; Milena Nikolic; Deivis G Morales Castellano; Ariane Steindl; Sarah Macheck; M Riegler; Ivan Kristo; Barbara Zörner; Sebastian F Schoppmann Journal: Sci Rep Date: 2018-05-09 Impact factor: 4.379
Authors: Katrin Schwameis; Milena Nikolic; Deivis G Morales Castellano; Ariane Steindl; Sarah Macheck; Ivan Kristo; Barbara Zörner; Sebastian F Schoppmann Journal: World J Surg Date: 2018-10 Impact factor: 3.352