Virginia Commonwealth University Health System Richmond, VA, United States
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 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.
Figure: KM Graph showing 30-day readmission
Sachit Sharma indicated no relevant financial relationships.
Ashu Acharya indicated no relevant financial relationships.
Sami Ghazaleh indicated no relevant financial relationships.
Muhammad Aziz indicated no relevant financial relationships.
Azizullah Beran indicated no relevant financial relationships.
Ishaan Vohra indicated no relevant financial relationships.
Subash Ghimire indicated no relevant financial relationships.
Sadikshya Sharma indicated no relevant financial relationships.
Ravi Vachhani indicated no relevant financial relationships.
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.