Kanwal Bains, MBBS, CNSC1, Aalam Sohal, MD2, Hunza Chaudhry, MD3, Shivam Kalra, MBBS4, Isha Kohli, MBBS, CPH, MPH5, Rochak Bains, MD6, Dino Dukovic, BS7 1University of Arizona, Tucson, AZ; 2Liver Institute Northwest, Seattle, WA; 3University of California San Francisco, Fresno, CA; 4Trident Medical Center, Charleston, SC; 5Icahn School of Medicine at Mount Sinai, New York, NY; 6Merit Health Wesley Medical Center, Providence, RI; 7Ross University School of Medicine, Maramar, FL
Introduction: Gastroparesis(GP) is the most common motility disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. It is associated with significant non-gastrointestinal somatic complaints including anxiety and depression. Although Major Depressive Disorder is a known comorbidity in patients with Gastroparesis, its impact on outcomes is unknown. We assessed the impact of Depression on hospital resource utilization in patients with Gastroparesis.
Methods: We queried the National Inpatient Sample 2016-2020 to identify adult patients( > 18yrs) with a primary discharge diagnosis of Gastroparesis. Patients with missing demographics or mortality were excluded. Data were collected on patient demographics, Elixhauser Comorbidity Index (ECI), and etiology of gastroparesis (diabetic vs. non-diabetic). Patients were stratified into two groups based on the presence or absence of Depression. We compared the resource utilization measured by the length of stay (LOS) and total hospitalization charges between the two groups. The relationship between resource utilization and depression was assessed using the multivariate regression model.
Results: A total of 220,425 patients with GP were included in the analysis. Of these, 50,650 (22.9%) patients had concomitant depression. The majority of the patients with depression were aged between 18-44 years (44.7%), female (76.7%), had Medicare (45.1%) and were in the lowest income quartile (35.4%). There was a lower incidence of diabetic gastroparesis in patients with depression than those without (72.6% vs 76.7%, p< 0.001). Patients with depression had longer LOS (4.8 days vs 4.1 days, p< 0.001) and higher total hospitalization charges ( $42,450.2 vs. $39,433.5, p< 0.001). After adjusting for confounding factors, depression was associated with longer LOS ( adj. coeff 0.4 days, 95% CI-0.3-0.5, p< 0.001) and higher hospitalization charges ( adj. coeff $1,505 95% CI $410-$2,599, p< 0.001).
Discussion: Patients with concomitant Gastroparesis and Depression had higher resource utilization. Due to the involvement of the gut-brain axis in motility disorders including Gastroparesis, early identification of the depressive disorder should be made, and prompt Pharmacotherapy be initiated. Various therapies including Cognitive behavioral therapy (CBT) can be utilized in these patients after discharge to improve the quality of life and reduce further resource utilization in future hospitalizations.
Figure: The length of stay and Total Cost of Hospitalisation stratified by the presence of depression
Demographics
Absence of Depression n(%)
Presence of Depression n (%)
p-value
Age category
0.006
18-44
76,060 (44.8)
22,620 (44.66)
45-64
67,655 (39.85)
20,855 (41.17)
>65
26,060 (15.35)
7,175 (14.17)
Sex
Males
61,265 (36.09)
11,800 (23.3)
< 0.001
Females
108,510 (63.91)
38,850 (76.7)
Race
White
75,585 (44.52)
29,020 (57.3)
< 0.001
Black
62,490 (36.81)
13,470 (26.59)
Hispanic
23,440 (13.81)
6,005 (11.86)
Asian/Pacific Islander
2,685 (1.58)
560 (1.11)
Native American
990 (.58)
295 (.58)
Other
4,585 (2.7)
1,300 (2.57)
Primary expected payer
Medicare
69,055 (40.67)
22,850 (45.11)
< 0.001
Medicaid
45,010 (26.51)
13,455 (26.56)
Private
40,370 (23.78)
11,490 (2.69)
Uninsured
11,010 (6.49)
1,85 (3.65)
Median household income
Lowest quartile
67,445 (39.73)
17,930 (35.4)
< 0.001
Second quartile
44,620 (26.28)
13,230 (26.12)
Third quartile
35,395 (20.85)
11,890 (23.47)
Highest quartile
22,315 (13.14)
7,600 (15)
Elixhauser Comorbidities
0
2,935 (1.73)
0 0
< 0.001
1
10,740 (6.33)
680 (1.34)
2
23,995 (14.13)
2,675 (5.28)
>3
132,105 (77.81)
47,295 (93.38)
Underlying etiology
Diabetic Gastroparesis(DGP)
130,130 (76.65)
36,760 (72.58)
< 0.001
Disclosures:
Kanwal Bains indicated no relevant financial relationships.
Aalam Sohal indicated no relevant financial relationships.
Hunza Chaudhry indicated no relevant financial relationships.
Shivam Kalra indicated no relevant financial relationships.
Isha Kohli indicated no relevant financial relationships.
Rochak Bains indicated no relevant financial relationships.
Dino Dukovic indicated no relevant financial relationships.
Kanwal Bains, MBBS, CNSC1, Aalam Sohal, MD2, Hunza Chaudhry, MD3, Shivam Kalra, MBBS4, Isha Kohli, MBBS, CPH, MPH5, Rochak Bains, MD6, Dino Dukovic, BS7. P3372 - Depression Is Associated With Higher Resource Utilization in Patients With Gastroparesis: Analysis of 220,425 Hospitalizations, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
