P3720 - Predictors of Mortality After Heller Myotomy and Peroral Endoscopic Myotomy in Achalasia

Umesh Bhagat, MD¹, Prashanthi N. Thota, MD¹, Siva Raja, MD¹, Madhusudhan R.. Sanaka, MD¹, Shalini Tripathi, MD^2
1Cleveland Clinic Foundation, Cleveland, OH; ²Carolina East Medical Center, New Bern, NC

Introduction: Heller myotomy (HM) is considered the gold standard for treatment of achalasia. Peroral endoscopic myotomy (POEM) is a novel, minimally invasive endoscopic alternative, that is emerging as the dominant treatment option over the past decade. There is a paucity of data regarding mortality after these two procedures. In this study, we aimed to assess and compare the rates and predictors of mortality after these two procedures from a national database.

Methods: We queried the National Readmission Database (NRD) database from 2015 to 2020, using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the patients with a primary diagnosis of Achalasia, who underwent HM or POEM. The primary outcome was mortality. Analysis was performed with STATA software. T-test was used for continuous variables and the chi-square test was used for categorical variables. Logistic as well as multivariate regression was used to identify risk factors associated with mortality.

Results: There were a total of 14918 patients that underwent HM and 2920 patients that underwent POEM for Achalasia. The mortality was 0.19% (25) in the HM group and 0.33% (8) in the POEM group during the index hospitalization. The rate of mortality after 30 days of readmission due to any cause was 1.96% (10) and 1.2% (1) respectively. Comorbidities such as congestive heart failure (CHF), Cardiac Arrhythmia, history of alcohol abuse, preprocedural acute kidney injury (AKI), peripheral vascular disease (PVD), and Rheumatoid arthritis (RA) increased the odds of mortality in patients undergoing HM. On adjusting for baseline characteristics, the adjusted odds were only significant for preprocedural AKI and cardiac arrhythmia in this group. In patients undergoing POEM the odds of mortality were high in groups with CHF, PVD, and preprocedural AKI, after adjusting CHF and preprocedural AKI were significant.

Discussion: In this national database study, we found that both HM and POEM were found to be very safe with low mortality rates. Comorbidities were major predictors of mortality in both treatment groups. Preprocedural optimization of comorbidities is warranted for patients undergoing these procedures to reduce the mortality further.


Disclosures:


Umesh Bhagat, MD¹, Prashanthi N. Thota, MD¹, Siva Raja, MD¹, Madhusudhan R.. Sanaka, MD¹, Shalini Tripathi, MD². P3720 - Predictors of Mortality After Heller Myotomy and Peroral Endoscopic Myotomy in Achalasia, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.