Hospitalization for esophageal achalasia in the United States

• 作者: Anne O Lidor Benedetto Mungo Daniela Molena Miloslawa Stem
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: ESOPHAGEAL ACHALASIA OUTCOMES MYOTOMY
• 年，卷（期）: 2015,（13）
• 页码范围: 1096-1102
• 页数: 7页
• 分类号: R656

摘要

AIM: To assess the outcome of different treatments in patients admitted for esophageal achalasia in the United States.METHODS: This is a retrospective analysis using the Nationwide Inpatient Sample over an 8-year period(2003-2010). Patients admitted with a primary diagnosis of achalasia were divided into 3 groups based on their treatment:(1) Group 1: patients who underwent Heller myotomy during their hospital stay;(2) Group 2: patients who underwent esophagectomy; and(3) Group 3: patients not undergoing surgical treatment. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay(LOS), discharge destination and total hospital charges.RESULTS: Among 27141 patients admitted with achalasia, nearly half(48.5%) underwent Heller myotomy, 2.5% underwent esophagectomy and 49.0% had endoscopic or other treatment. Patients in group 1 were younger, healthier, and had the lowest mortality when compared with the other two groups. Group 2 had the highest LOS and hospital charges among all groups. Group 3 had the highest mortality(1.2%, P < 0.001) and the lowest home discharge rate(78.8%) when compared to the other groups. The most frequently performed procedures among group 3 were esophageal dilatation(25.9%) and injection(13.3%). Among patients who died in this group the most common associated morbidities included acute respiratory failure, sepsis and aspiration pneumonia. CONCLUSION: Surgery for achalasia carries exceedingly low mortality in the modern era; however, in complicated patients, even less invasive treatments are burdened bysignificant mortality and morbidity.