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A Population-Based Study, 1996 to 2000

Leena Khaitan, MD, MPH; Wayne A. Ray, PhD; Michael D. Holzman, MD, MPH; Walter E. Smalley, MD, MPH

Arch Surg. 2003;138:1356-1361.

Hypothesis  Patients who undergo surgical treatment for gastroesophageal reflux disease (GERD) will use fewer health care resources than those who continue to be treated medically during the same follow-up period.

Design  Matched cohort study of patients with a diagnosis of GERD receiving surgical therapy or medical therapy.

Setting  Tennessee Medicaid (TennCare) program from 1996 through 2000.

Patients  Population-based sample of 7635 TennCare enrollees with a diagnosis of GERD served as the underlying population. Of these, 111 surgical patients who underwent fundoplication in 1996 met inclusion criteria. The 200 patients in the medically treated cohort were randomly matched to patients in the surgical cohort by demographic characteristics and previous use of acid-suppressing drugs.

Interventions  The surgical group all underwent fundoplication in 1996. The medical group was treated without fundoplication.

Main Outcome Measures  Health care utilization (medication use, outpatient visits, hospitalizations, and diagnostic studies) for each cohort through December 2000.

Results  In the 4-year follow-up period, the surgical group had fewer GERD-related outpatient physician visits (5.5 ± 6.9 visits vs 6.7 ± 6.1 visits; P = .10). Utilization of other types of outpatient and inpatient care was similar. During each year of follow-up, the proportion of persons using GERD medication was lower in the surgical group. (0.67 vs 0.93 in year 1, 0.67 vs 0.91 in year 2, 0.72 vs 0.85 in year 3, and 0.74 vs 0.90 in year 4).

Conclusion  The utilization of health care resources in patients treated surgically for GERD is associated with a modest decrease in the use of GERD-related medications and GERD-related visits.

From the Departments of Surgery (Drs Khaitan, Holzman and Smalley), Preventive Medicine (Drs Ray and Smalley), and Medicine (Dr Smalley), Vanderbilt University School of Medicine, Vanderbilt University Center for Education and Research on Therapeutics, and the Geriatric Research, Education, and Clinical Center, Nashville Veterans Affairs Center (Drs Ray and Smalley), Nashville, Tenn. Dr Khaitan is now with the Department of Surgery, Emory University, Atlanta, Ga.

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