Introduction: In the United States, a small number of patients, labeled as super-utilizers accounts for a disproportionately large fraction of healthcare expenditure. The knowledge about the characteristics of super-utilizers and their impact on healthcare utilization would be helpful to various stakeholders to target interventions aimed at reducing the disproportionate use of the healthcare system. Methods: We extracted data from the Nationwide Readmission Database (NRD) 2019, on patients admitted primarily with a gastrointestinal (GI) pathology. We used Agency for Healthcare Research and Quality’s definition for super-utilizers (2 standard deviations above the average number of hospital stays for patients in each payer category which were ≥4 for Medicaid/Medicare and ≥3 for privately /uninsured in 2019). We collected data on demographics, readmission rates, and hospitalization costs. Results: Of 1,704,913 patients who were discharged alive, 6.3% were categorized as super-utilizers. The highest proportion of super-utilizers was observed among patients with hepatic failure (19.6%), non-infectious hepatitis (13.6%), and inflammatory bowel disease (10.4%) (Figure 1). On multivariate analysis, several characteristics were independently associated with super-utilizers, especially the comorbidity burden and disease severity (Table 1). The mean number of admissions for an average super-utilizer was ∼4 times compared to other patients (mean admissions: 5.5 vs 1.4; P < 0.001). Super-utilizers were mostly admitted for medical diagnosis (83.4% vs 67.3%) as compared to surgical (16.5% vs 31.4%) and for non-elective reasons (92.1% vs 88.9%). The 30-day readmission rate was ∼6 times higher among super-utilizers compared to other patients (36.6% vs 6.4% P < 0.001). Compared to other patients, super-utilizers had longer hospital stays (mean days: 5.8 vs 4.4; P < 0.001) and higher average hospitalization costs (mean US$: 15060 vs 13023; P < 0.001). Super-utilizers although only 6.3%, accounted for 31.5% of hospitalization days, 28.2% of costs, 19.6% of hospital stays, and 27.3% of all-cause 30-day readmissions. These findings were consistent across the different payer types on subgroup analysis. Conclusion: 6.3% of patients admitted with a GI diagnosis were classified as super-utilizers. Comorbidity burden and disease severity were strongly associated with super-utilizers. Super-utilizers accounted for a disproportionate share of hospital days, costs, stays, and 30-day readmissions compared to other patients.Figure 1.: Percentage of super-utilizers among various GI pathologies resulting in hospitalization in 2019. Table 1. - Multivariate analysis showing association between super-utilizer status and various patient- and hospital-level characteristics Characteristics Odds Ratio [95% CI] ‘P’ value Charlson Comorbidity index 1.70 (1.68-1.73) < 0.001 Severity 1.37 (1.35-1.38) < 0.001 Teaching hospital 1.21 (1.15-1.28) < 0.001 Hospital Bed size 1.05 (1.03-1.07) < 0.001 Hospital control 1.04 (1.01-1.07) 0.006 Age 0.98 (0.98-0.98) < 0.001 Income 0.98 (0.97-0.99) < 0.001 Female gender 0.97 (0.95-0.98) < 0.001 Urban location 0.88 (0.83-0.92) < 0.001