Safety and efficacy of robotic anti-reflux surgery in geriatric patients: a comparative analysis.

TitleSafety and efficacy of robotic anti-reflux surgery in geriatric patients: a comparative analysis.
Publication TypeJournal Article
Year of Publication2024
AuthorsMarshall TE, Alqamish M, Salehi N, Asadi HAl, Lee-Saxton YJ, Tumati A, Greenspun B, Finnerty BM, Fahey TJ, Zarnegar R
JournalSurg Endosc
Volume38
Issue9
Pagination5285-5291
Date Published2024 Sep
ISSN1432-2218
KeywordsAged, Aged, 80 and over, Female, Fundoplication, Gastroesophageal Reflux, Humans, Length of Stay, Male, Patient Readmission, Postoperative Complications, Quality of Life, Reoperation, Retrospective Studies, Robotic Surgical Procedures, Treatment Outcome
Abstract

INTRODUCTION: As our population ages, older adults are being considered for anti-reflux surgery (ARS). Geriatric patients typically have heightened surgical risk, and literature has shown mixed results regarding postoperative outcomes. We sought to evaluate the safety and efficacy of robotic ARS in the geriatric population.

METHODS: We conducted a single-institution review of ARS procedures performed between 2009 and 2023. Patients ≥ 65 were assigned to the geriatric cohort. We compared operative details, lengths of stay (LOS), readmissions, reoperations, and complications between the two cohorts. The gastroesophageal reflux disease health-related quality of life (GERD-HRQL) survey and review of clinic notes were used to evaluate ARS efficacy.

RESULTS: 628 patients were included, with 190 in the geriatric cohort. This cohort had a higher frequency of diabetes (16.3% vs 5.9% p < 0.0001), hypertension (50.0% vs 21.5% p < 0.0001), and heart disease (17.9% vs 2.3% p < 0.0001). Geriatric patients were more likely to exhibit hiatal hernias on imaging (51.6% vs 34.2% p < 0.0001) and were more likely to have large hernias (30.0% vs 7.1% p < 0.0001). Older adults were more likely to undergo Toupet fundoplications (58.4% vs 41.3%, p < 0.0001), Collis gastroplasties (9.5% vs 2.7% p < 0.0001), and relaxing incisions (11.6% vs 1.4% p < 0.0001). Operative time was longer for geriatric patients (132.0 min vs 104.5 min p < 0.0001). There were no significant differences in LOS, readmissions, or reoperations between cohorts. Geriatric patients exhibited lower rates of complications (7.4% vs. 14.6%, p = 0.011), but similar complication grades. Both groups had significant reduction in symptom scores from preoperative values. There were no significant differences in the reported symptoms between cohorts at any follow-up timepoint.

CONCLUSION: Geriatric robotic ARS patients tend to do as well as younger adults regarding postoperative and symptomatic outcomes, despite presenting with larger hiatal hernias and shorter esophagi. Clinicians should be aware of possible need for lengthening procedures or relaxing incisions in this population.

DOI10.1007/s00464-024-11037-w
Alternate JournalSurg Endosc
PubMed ID39009731
PubMed Central ID4066007