Anti‐Reflux Procedures in Australia, 2000/1 to 2023/4: Increasing Rates in Females and in Older Patients

BACKGROUND: Gastro-oesophageal reflux disease (GORD) is common, and surgery can benefit patients with refractory symptoms. However, the uptake and effectiveness of surgery vary between patient subgroups. Understanding long-term national trends is essential to inform clinical practice and service planning. METHODS: This population-based study analysed age-adjusted national data on anti-reflux procedures, paraoesophageal hiatal hernia (POH) repair, and gastroscopies in Australian adults (≥ 18 years) from 2000 to 2024. Age-standardised and age-sex-specific rates were calculated to examine trends. RESULTS: Rates for POH and reflux surgery increased by 245.6% (p < 0.001) over the study. POH repair accounted for 57.9% of procedures, increasing by 4924.7% (6.1 to 304.3 procedures/million/year, p < 0.001). Fundoplasty without POH repair declined by 65.9% (100.4 to 34.3 procedures/million/year, p < 0.001), but the less common cardiopexy increased by 3395.8% (1.4 to 49.5 procedures/million/year, p < 0.001). CONCLUSION: Over two decades, Australia experienced a substantial shift in the surgical management of GORD, characterised by increasing utilisation of POH repair and a decline in isolated fundoplasty. Females had higher rates than males and increased most markedly in older individuals. These findings outline evolving operative patterns in GORD management and highlight the need for further research into the factors underlying these sex and age-related disparities, which may have important implications for clinical decision-making and patient outcomes.