B0452 - Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy (POEM): A Snapshot of the United States Population

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Dushyant S. Dahiya, MD

Central Michigan University College of Medicine
Saginaw, MI

Dushyant S. Dahiya, MD¹, Abhilash Perisetti, MD², Hemant Goyal, MD³, Sumant Inamdar, MD, MPH⁴, Amandeep Singh, MD⁵, Rajat Garg, MD⁵, Madhu Vennikandam, MD⁶, Sailaja Pisipati, MBBS, FRCS⁷, Chin-I Cheng, PhD⁸, Mohammad Al-Haddad, MD, MSc⁹, Madhusudhan Sanaka, MD¹⁰, Neil Sharma, MD¹¹
¹Central Michigan University College of Medicine, Saginaw, MI; ²Parkview Cancer Institute, Fort Wayne, IN; ³University of Texas McGovern Medical School, Houston, TX; ⁴University of Arkansas for Medical Sciences, Little Rock, AR; ⁵Cleveland Clinic Foundation, Cleveland, OH; ⁶Sparrow Hospital/Michigan State University College of Human Medicine, Lansing, MI; ⁷Mayo Clinic, Scottsdale, AZ; ⁸Central Michigan University, Mount Pleasant, MI; ⁹Indiana University School of Medicine, Indianapolis, IN; ¹⁰Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; ¹¹Parkview Cancer Institute. Indiana University School of Medicine, Fort Wayne, IN

Introduction: Achalasia is a neurodegenerative motility disorder of the esophagus characterized by ineffective lower esophageal sphincter (LES) relaxation and peristalsis leading to progressive dysphagia. Per-Oral Endoscopic Myotomy (POEM) is a rapidly emerging minimally invasive procedure for management of achalasia. In this study, we aimed to investigate hospitalization characteristics and outcomes for achalasia patients who were hospitalized after POEM in the United States (US).

Methods: The National Inpatient Sample was utilized for 2016–2019 to identify all adult (≥18 years) achalasia patients in the US who were admitted after POEM. Patients’ demographic characteristics, outcomes, and complications were highlighted. P-values ≤0.05 were considered statistically significant.

Results: In the US, 1,885 achalasia patients were admitted to the hospital after POEM between 2016–2019. There was an increase in the total number of admissions after POEM from 380 in 2016 to 490 in 2019 (Figure 1). The mean age for these admissions increased from 54.2 years in 2016 to 59.3 years in 2019. Most hospitalizations were for the 65–79 age group (31.8%), females (50.4%), and Whites (68.4%), mainly at large (86.2%) urban teaching (96.3%) hospitals (Table 1). The Northeast (33.7%) and South (32.4%) hospital regions had the highest number of POEM-related hospitalizations. Furthermore, a majority of the study population was eventually discharged home (88.3%). There was no inpatient mortality. The mean length of stay (LOS) decreased from 4 days in 2016 to 3.2 days in 2019, while the mean total healthcare charge (THC) increased from $52,057 in 2016 to $65,109 in 2019. Esophageal perforation was the most common complication noted for 1.3% of all patients, while post-procedure pneumonia was only observed in 0.8% of the study cohort (Table 1).

Discussion: Same-day discharges after POEM are safe and feasible. However, some patients may be hospitalized post-procedure. In this study, we noted an increase in the number of achalasia patients who were hospitalized after POEM between 2016 to 2019, mainly at large urban teaching centers. Furthermore, there was no POEM-related mortality and rates of complications were extremely low, reflecting an excellent safety profile of this advanced procedure. We noted a decrease in the mean LOS for these hospitalizations which may be attributed to improvements in the management strategies as familiarity with the procedure increased.

Figure: Figure 1: Trends for Achalasia patients who were admitted to the hospital after Per-Oral Endoscopic Myotomy (POEM) in the United States from 2016 to 2019.

Epidemiological Variable			YEARS
	2016	2017	2018	2019	2016-2019 (Overall)
Total Number of Per-Oral Endoscopic Myotomy	380	570	445	490	1,885
Mean Age (years) ± Standard Error	54.2 ± 1.4	56.8 ± 1.5	59.6 ± 1.9	59.3 ± 2.0	57.6 ± 0.9
Age Group Distribution (years)
18 – 34	80 (21.1%)	105 (18.4%)	40 (9.0%)	60 (12.2%)	285 (15.1%)
35 – 49	75 (19.7%)	80 (14.0%)	75 (16.9%)	75 (15.3%)	305 (16.2%)
50 – 64	115 (30.3%)	155 (27.2%)	155 (34.8%)	115 (23.5%)	540 (28.7%)
65 – 79	90 (23.7%)	195 (34.2%)	115 (25.8%)	200 (40.8%)	600 (31.8%)
≥ 80	20 (5.3%)	35 (6.1%)	60 (13.5%)	40 (8.2%)	155 (8.2%)
Gender
Male	185 (48.7%)	270 (47.4%)	220 (49.4%)	260 (53.1%)	935 (49.6%)
Female	195 (51.3%)	300 (52.6%)	225 (50.6%)	230 (46.9%)	950 (50.4%)
Race
White	275 (76.4%)	380 (69.7%)	270 (62.1%)	320 (66.7%)	1,245 (68.4%)
Black	45 (12.5%)	90 (16.5%)	75 (17.2%)	60 (12.5%)	270 (14.8%)
Hispanic	30 (8.3%)	45 (8.3%)	50 (11.5%)	50 (10.4%)	175 (9.6%)
Asian	< 11 (1.4%)	0 (0.00%)	15 (3.5%)	30 (6.3%)	50 (2.8%)
Others	< 11 (1.4%)	30 (5.5%)	25 (5.8%)	20 (4.2%)	80 (4.4%)
Charlson Comorbidity Index (CCI)
CCI = 0	230 (60.5%)	350 (61.4%)	220 (49.4%)	260 (53.1%)	1,060 (56.2%)
CCI = 1	55 (14.5%)	130 (22.8%)	120 (27.0%)	150 (30.6%)	455 (24.1%)
CCI = 2	50 (13.2%)	40 (7.0%)	50 (11.2%)	40 (8.2%)	180 (9.6%)
CCI ≥ 3	45 (11.8%)	50 (8.8%)	55 (12.4%)	40 (8.2%)	190 (10.1%)
Hospital Region
Northeast	135 (35.5%)	205 (36.0%)	120 (27.0%)	175 (35.7%)	635 (33.7%)
Midwest	125 (32.9%)	135 (23.7%)	85 (19.1%)	60 (12.2%)	405 (21.5%)
South	80 (21.1%)	165 (29.0%)	170 (38.2%)	195 (39.8%)	610 (32.4%)
West	40 (10.5%)	65 (11.4%)	70 (15.7%)	60 (12.2%)	235 (12.5%)
Hospital Bed Size
Small	< 11 (1.3%)	0 (0.0%)	15 (3.4%)	25 (5.1%)	45 (2.4%)
Medium	25 (6.6%)	95 (16.7%)	45 (10.1%)	50 (10.2%)	215 (11.4%)
Large	350 (92.1%)	475 (83.3%)	385 (86.5%)	415 (84.7%)	1,625 (86.2%)
Hospital Location & Teaching Status
Rural	< 11 (1.3%)	< 11 (0.9%)	0 (0.0%)	0 (0.0%)	< 11 (0.5%)
Urban Non-teaching	15 (4.0%)	25 (4.4%)	< 11 (1.1%)	15 (3.1%)	60 (3.2%)
Urban Teaching	360 (94.7%)	540 (94.7%)	440 (98.9%)	475 (96.9%)	1,815 (96.3%)
Discharge Home	340 (89.5%)	495 (86.8%)	390 (87.6%)	440 (89.8%)	1,665 (88.3%)
Inpatient Mortality	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Length of Stay	4.0	3.7	3.9	3.2	3.7
Total Healthcare Charge ($)	52,057	75,240	67,520	65,109	66,151
Complications
Major Post-Procedural Hemorrhage	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Esophageal Perforation	< 11 (1.3%)	< 11 (0.9%)	< 11 (1.1%)	< 11 (2.0%)	25 (1.3%)
Post-Procedure Sepsis	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Post-Procedure Pneumonia	< 11 (1.3%)	0 (0.0%)	< 11 (1.1%)	< 11 (1.0%)	15 (0.8%)

Table: Table 1: Trends and outcomes for patients with achalasia who were admitted after Per-Oral Endoscopic Myotomy (POEM) in the Unites States from 2016 to 2019.

Disclosures:

Dushyant Dahiya indicated no relevant financial relationships.

Abhilash Perisetti indicated no relevant financial relationships.

Hemant Goyal: Aimloxy LLC – Consultant.

Sumant Inamdar indicated no relevant financial relationships.

Amandeep Singh indicated no relevant financial relationships.

Rajat Garg indicated no relevant financial relationships.

Madhu Vennikandam indicated no relevant financial relationships.

Sailaja Pisipati indicated no relevant financial relationships.

Chin-I Cheng indicated no relevant financial relationships.

Mohammad Al-Haddad: Amplified sciences – Grant/Research Support. Cook endoscopy – Grant/Research Support. Creatics LLC – Grant/Research Support.

Madhusudhan Sanaka indicated no relevant financial relationships.

Neil Sharma indicated no relevant financial relationships.