P0832 - National Patterns and Shifts in Utilization of Esophageal Stents: Insights from National Inpatient Sample Database 2016 to 2020

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

AN

Ahmad Nawaz, MD

Yale University School of Medicine
New Haven, CT

Ahmad Nawaz, MD¹, AbdelKader Chaar, MD¹, Shanti Patel, MD¹, Rabia Rizwan, MD¹, Fatima Khalid, MBBS², Dhruv Mehta, MD³
¹Yale University School of Medicine, New Haven, CT; ²FMH College of Medicine and Dentistry, Lahore, Punjab, Pakistan; ³UT Health San Antonio, San Antonio, TX

Introduction: Esophageal stents (ES) are extensively used for palliating dysphagia from malignant obstruction. They are increasingly being used in the management of esophageal perforation and benign strictures from a variety of causes. Our study aims to analyze national patterns and shifts in utilization of ES focusing on both benign and malignant causes. Additionally, we also investigated trends in systemic complications associated with hospitalizations requiring ES.

Methods: A retrospective cohort study was conducted using the National Inpatient Sample (NIS) database from 2016 to 2020. All adult patients that require endoscopic placement of ES were included. The Cochrane-Armitage trend test was used to assess statistical significance in the number of hospital discharges, demographics and systemic compilations over the study period.

Results: We identified an increase in hospitalizations requiring ES for benign etiology as compared to malignant etiology, but the trend was not statistically significantly. There was a significant increase in hospitalizations requiring ES for esophageal perforation as seen in the Figure 1 (27.45% in 2016 to 46.05% in 2020; p=0.008). From 2016 to 2020, an increased rate of systemic complications was noted in the patients that were admitted requiring ES; cardiac complications (10.78% in 2016 to 36.84% in 2020; p=0.001), pulmonary complications (44.12% in 2016 to 59.21% in 2020; p=0.040), gastrointestinal (GI) complications (28.43% in 2016 to 43.42% in 2020; p=0.029) and infectious disease (ID) complications (35.29% in 2016 to 50.00% in 2020; p=0.034).

Discussion: We observed a trend showing increase utilization of ES for benign etiologies, most significantly for esophageal perforation, laceration and bleeding. We also noticed a significant increase in pulmonary, GI, cardiac and ID complications during hospital admissions requiring ES. This increased rate in systemic complications need further research as to clear out whether hospitalized patients that required ES were more morbid or rate of complications for ES have increased.

Figure: Graph: 5-year trend of etiology and complications of patients that required ES during hospitalization.

	2016	2017	2018	2019	2020	p-value
Age (mean)	60.86	60.27	63.00	60.59	61.75
Male, %	61.76	58.33	57.69	62.30	65.79	0.849
Race, %						0.563
White	77.42	73.77	72.37	76.27	76.71
Black	16.13	9.84	7.89	10.17	10.96
Hispanic	5.38	11.48	10.53	6.78	10.96
Hospital region, %						0.359
Northeast	17.65	22.22	23.08	29.51	11.84
Midwest	28.43	31.94	23.08	24.59	30.26
South	35.29	23.61	26.92	21.31	34.21
West	18.63	22.22	26.92	24.59	23.68
Hospital location and teaching status, %						0.019
Rural	3.92	4.17	0.00	0.00	1.32
Urban nonteachting	15.69	4.17	19.23	6.56	9.21
Urban teaching	80.39	91.67	80.77	93.44	89.47
Median household income, %						0.685
Quartile 1	36.00	22.54	26.92	20.00	24.32
Quartile 2	22.00	29.58	32.05	30.00	28.38
Quartile 3	25.00	22.54	23.08	25.00	24.32
Quartile 4	17.00	25.35	17.95	25.00	22.97
Etiology, %
Malignancy	29.41	30.56	32.05	40.98	31.58	0.399
Perforation, Laceration and Bleeding	27.45	31.94	38.46	37.70	46.05	0.008
Non-malignant Esophageal Stricture	22.55	18.06	23.08	21.31	18.42	0.677
Upper GI Bleeding	14.71	12.50	7.69	6.56	10.53	0.174
Esophageal Leak or Fistula	5.88	8.33	3.85	1.64	3.95	0.203
Achalasia	1.96	2.78	1.28	4.92	1.32	0.916
Systemic Complications, %
Pulmonary Complications	44.12	50.00	46.15	55.74	59.21	0.040
GI Complications	28.43	30.56	38.46	36.07	43.42	0.029
ID Complications	35.29	47.22	35.90	54.10	50.00	0.034
Cardiac Complications	10.78	15.28	17.95	19.67	36.84	0.001

Table: 5-year trend of hospitalizations in patients that required Esophageal Stent.

Disclosures:

Ahmad Nawaz indicated no relevant financial relationships.

AbdelKader Chaar indicated no relevant financial relationships.

Shanti Patel indicated no relevant financial relationships.

Rabia Rizwan indicated no relevant financial relationships.

Fatima Khalid indicated no relevant financial relationships.

Dhruv Mehta indicated no relevant financial relationships.

Ahmad Nawaz, MD¹, AbdelKader Chaar, MD¹, Shanti Patel, MD¹, Rabia Rizwan, MD¹, Fatima Khalid, MBBS², Dhruv Mehta, MD³. P0832 - National Patterns and Shifts in Utilization of Esophageal Stents: Insights from National Inpatient Sample Database 2016 to 2020, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.