P0301 - Association of Preoperative Diagnostic Results and Patient Comorbidities on Risk of Gastroesophageal Surgical Failure

Rohin Gawdi, BS¹, Zach German, BSPH¹, Ana Patel, BA¹, Carl Westcott, MD², Steven Clayton, MD^2
1Wake Forest University School of Medicine, Winston-Salem, NC; ²Wake Forest Baptist Health, Winston-Salem, NC

Introduction: While rates of surgical failure in fundoplication and hiatal hernia repair are low, data evaluating preoperative features of patients who do experience surgical failure has been largely contradictory and unclear.

Methods: Patients who underwent anti-reflux surgery at Wake Forest Baptist Medical Center between 2016-2019 were considered for this study. Each patient was evaluated for evidence of surgical failure, requiring either reoperation, high-dose PPI, recurrence or new onset of hiatal hernia, or evidence of new erosive esophageal disease. Patients who qualified as having failed surgeries and control patients (patients who underwent anti-reflux operation without requiring any of the above criteria were identified. Demographic data, comorbidities, clinical presentation, preoperative evaluation, and surgical data were collected for both cohorts.

Results: 87 patients with failure and 44 controls were identified among our cohort. Of demographic data, no significant differences were found between groups based on gender (p=0.640). However, patients with failure were younger than controls (57.0 vs 64.7, p=< 0.0001). BMI was not significantly different between groups (p=0.189). No significant differences were found between groups based on alcohol (p = 0.060) or tobacco (p = 0.999) use. Notably, as suggested in prior research, psychiatric illness more common in the failure group (p=0.0086), however neither hypertension (p=0.134) nor diabetes (p=0.335) were more common in the failure group. No significant differences were found between groups for the presence of preoperative imaging (p=0.395) and manometry (p = 0.374), however pH/BRAVO studies (p=0.0193) and endoscopy (p=< 0.0001) were both performed more frequently in the failure group than the control group.

Discussion: Our analysis suggests that younger patients who had psychiatric comorbidities may be more likely to experience failure. This is consistent with prior literature on the topic. Neither alcohol nor tobacco use were associated with failure, a finding that warrants further analysis. We also saw no decrease in rates of preoperative testing in the failure group when compared to controls, which is contrary to other studies on the topic.

	Failure Group	Control Group	p-value
Age (mean/SD)	57.0 (14.5)	64.7 (10.2)	p = < 0.0001**
Gender
Male	18 (21.18%)	7 (16.67%)	p = 0.640
Female	67 (78.82%)	35 (83.33%)
BMI (mean/SD)	31.8 (7.53)	34.0 (10.1)	p = 0.189
Alcohol Use
No	57 (67.06%)	35 (83.33%)	p = 0.06
Yes/Former	28 (32.94%)	7 (16.67%)
Tobacco Use
No	47 (54.65%)	23 (54.76%)	p = 0.999
Yes/Former	39 (45.35%)	19 (32.24%)
Hypertension
No	41 (47.67%)	14 (33.33%)	p = 0.134
Yes	45 (52.33%)	28 (66.67%)
Diabetes Mellitus
No	76 (88.37%)	40 (95.24%)	p = 0.335
Yes	10 (11.63%)	28 (4.76%)
Psychiatric Illness
No	40 (46.51%)	30 (71.43%)	p = 0.0086**
Yes	46 (53.49%)	12 (28.57%)
Imaging Performed
No	9 (10.47%)	7 (16.67%)	p = 0.395
Yes	77 (89.53%)	35 (83.33%)
Manometry Performed
No	62 (72.09%)	36 (85.71%)	p = 0.120
Yes	24 (27.91%)	6 (14.29%)
pH Study/BRAVO Performed
No	68 (79.07%)	40 (95.24%)	p = 0.0193**
Yes	18 (20.93%)	2 (4.76%)
Endoscopy Performed
No	45 (52.33%)	38 (90.48%)	p = < 0.0001
Yes	41 (47.67%)	4 (9.52%)

Table: Demographics, Comorbidities, and Preoperative Testing between Failure and Control Groups.
Abbreviations: SD, standard deviation; BMI, body mass index.


Disclosures:
Rohin Gawdi indicated no relevant financial relationships.
Zach German indicated no relevant financial relationships.
Ana Patel indicated no relevant financial relationships.
Carl Westcott indicated no relevant financial relationships.
Steven Clayton indicated no relevant financial relationships.


Rohin Gawdi, BS¹, Zach German, BSPH¹, Ana Patel, BA¹, Carl Westcott, MD², Steven Clayton, MD². P0301 - Association of Preoperative Diagnostic Results and Patient Comorbidities on Risk of Gastroesophageal Surgical Failure, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.