Twenty-year trends in the utilization of Heller myotomy for achalasia in the United States

Introduction: Trends in the utilization of Heller myotomy for achalasia in the U.S. over time have not been previously described. Materials and methods: Using the Nationwide Inpatient Sample (NIS) database, we analyzed patients undergoing Heller myotomy for achalasia over a 20-year period (1992-2011) to estimate rates of Heller myotomy, locations where the procedures were performed (rural, urban or teaching) and changes in technique (laparoscopic vs open) as well as outcomes of length of stay and in-hospital mortality. Results: Over the last 20 years, the total number of Heller myotomies performed in the U.S. has increased (1576 cases in 1992 to 5046 cases in 2011, p = 0.001). These procedures are now being performed laparoscopically (0.9%-67.0%, p < 0.001) and at urban teaching hospitals (45.4%-77.1%, p < 0.001). In-hospital mortality has decreased (0.9%-0.3%, p = 0.006). Hospital length of stay has decreased from 7 days to 2 days (p < 0.001). Discussion: These data show a trend of increasing utilization of laparoscopic Heller myotomy at teaching institutions with decreased in-hospital mortality and shorter LOS. Summary: Heller myotomy has been the mainstay of treatment for achalasia in the United States over the last 20 years, with increase in the number of Heller myotomies performed over time. With this, there has been a concomitant increase in utilization of the laparoscopic approach and an increase in the percentage of procedures done in urban teaching hospitals. Patient outcomes have improved over this time period, with decreased in-hospital mortality and LOS.