Umesh Bhagat, MD1, Prashanthi N. Thota, MD1, Siva Raja, MD1, Madhusudhan R.. Sanaka, MD1, Shalini Tripathi, MD2 1Cleveland Clinic Foundation, Cleveland, OH; 2Carolina East Medical Center, New Bern, NC
Introduction: Achalasia is a motility disorder of the esophagus due to loss of peristalsis of the lower esophagus and failure of LES(Lower esophageal sphincter) to relax causing dysphagia.The most common surgical technique used to treat achalasia is called the Heller Myotomy (HM), which is the gold standard. Per-oral esophageal Myotomy (POEM) is a novel endoscopic technique that has gained considerable traction over the past decade. The data regarding 30-day readmission is lacking. Here we attempt to identify rates and predictors of readmission, cumulative incidence, and most common cause of readmission in these groups.
Methods: We queried the National Readmission Database (NRD) database from the fourth quarter of 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 predictors of readmission. Analysis was performed with STATA software. T-test was used for continuous variables and the chi-square test was used for categorical variables. Survival analysis was done where unadjusted and adjusted hazard ratio was calculated. Cumulative incidence was calculated to compare the risk of readmission.
Results: The study looked at 14918 patients that underwent HM and 2920 patients that underwent POEM for Achalasia. 510 patients were readmitted after HM and 111 after POEM. The most common cause for readmission in HM was reoccurrence of achalasia compared to unspecified gastrointestinal hemorrhage in POEM. An increased risk of readmission in POEM was seen in patients who had pneumothorax and UGI bleeding. It was also statistically significant in patients with a history of paralysis. In the HM group increased risk was seen in sepsis. It was also significant in patients with a history of neurological disease. The cumulative incidence of readmission at 30 days was higher in the POEM group compared to HM (log-rank P < 0.001)
Discussion: Both POEM and HM are relatively safe procedures with rates of readmission which is comparable in both groups. POEM was performed in patients who had significant risk factors and were debilitated compared to HM. This can explain the increased 30-day cumulative incidence of readmission. We will need long-term follow-up studies to validate these results and decrease the rate of readmission in both groups.
Figure: Cumulative readmission incidence
Umesh Bhagat indicated no relevant financial relationships.
Prashanthi Thota indicated no relevant financial relationships.
Siva Raja indicated no relevant financial relationships.
Madhusudhan Sanaka indicated no relevant financial relationships.
Shalini Tripathi indicated no relevant financial relationships.
Umesh Bhagat, MD1, Prashanthi N. Thota, MD1, Siva Raja, MD1, Madhusudhan R.. Sanaka, MD1, Shalini Tripathi, MD2. P3721 - Comparative Analysis of Patients with Achalasia Undergoing POEM and HM: Predictors of Readmission, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.