S1218 National Patterns and Shifts in Utilization of Esophageal Stents: Insights from National Inpatient Sample Database 2016 to 2020

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) (Table 1). Conclusion: 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 1.: Graph: 5-year trend of etiology and complications of patients that required ES during hospitalization. Table 1. - 5-year trend of hospitalizations in patients that required Esophageal Stent 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