P0308 - Therapeutic Esophageal Dilation in the Inpatient Setting: Reasons, Outcomes, 30-Day Readmission Rate and Independent Predictors of Readmission - Insights From a Nationwide Analysis

Sachit Sharma, MD¹, Ashu Acharya, MD², Sami Ghazaleh, MD², Muhammad Aziz, MD², Azizullah Beran, MD², Ishaan Vohra, MD³, Subash Ghimire, MD⁴, Sadikshya Sharma, MD², Ravi Vachhani, MD^5
1Virginia Commonwealth University Health System, Richmond, VA; ²University of Toledo Medical Center, Toledo, OH; ³John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ⁴Guthrie Robert Packer Hospital, Sayre, PA; ⁵Virginia Commonwealth University, Richmond, VA

Introduction: Therapeutic Esophageal Dilation (TED) is a safe and effective procedure to treat dysphagia due to various reasons like strictures, rings, and obstructions. There is a paucity of studies looking at TED performed during inpatient admission. Therefore, we conducted this study to investigate the most common reasons, outcomes, and predictors of 30-day readmission in patients undergoing inpatient TED.

Methods: We queried the 2017 Nationwide Readmission Database (NRD) using ICD-10-CM procedure codes to identify all adult patients who underwent inpatient therapeutic esophageal dilation procedure. Outcomes assessed were most common reasons for TED, 30-day readmission rates, mortality, Length of Stay (LOS) and hospitalization costs. A multivariate cox regression was done to obtain Hazard Ratio (HR) and identify independent predictors of readmission.

Results: A total of 35,836 adult patients were identified who underwent TED in 2017, with in-hospital mortality rate of 2.6%. The most common primary diagnosis during the admission for TED was “Esophageal obstruction”. Of the patients discharged, 21.14% patients were readmitted within 30-days. The most common primary diagnosis at readmission was “Sepsis, unspecified organism” (8.19%). When compared to index admission, readmitted patients had higher in-hospital mortality (7.33% vs 2.65%, p< 0.01) but lower mean LOS (7.8 days vs 6.9 days, p< 0.01) and lower mean hospitalization charges ( $80,595 vs $68,528, p< 0.01). Readmission added 51,596 inpatient days and $50.5 million in hospitalization charges to the healthcare burden. Higher Charlson comorbidity score (HR 1.08, p< 0.01), longer LOS (HR 1.01, p< 0.01), ESRD (HR 1.27, p< 0.05) and CHF (HR 1.19, p< 0.01) were independent predictors of readmission. Female gender (HR 0.92, p< 0.05) and advancing age (HR 0.98, p< 0.01) were associated with lower likelihood of readmission.

Discussion: In the US, esophageal obstruction was the most common reason for admission in patients undergoing TED. About 1 in 5 patients are readmitted within 30-days of discharge. Readmission is associated with significantly increased in-hospital mortality but lower LOS, and hospitalization charges. Patients with CHF, ESRD and higher comorbidity burden were significantly more likely to be readmitted within 30-days, while advancing age and females were less likely to be readmitted. Further prospective studies are needed to assess the high-risk populations to address early readmission and improve value-based care.



Disclosures:


Sachit Sharma, MD¹, Ashu Acharya, MD², Sami Ghazaleh, MD², Muhammad Aziz, MD², Azizullah Beran, MD², Ishaan Vohra, MD³, Subash Ghimire, MD⁴, Sadikshya Sharma, MD², Ravi Vachhani, MD⁵. P0308 - Therapeutic Esophageal Dilation in the Inpatient Setting: Reasons, Outcomes, 30-Day Readmission Rate and Independent Predictors of Readmission - Insights From a Nationwide Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.