Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 25, 2015; 7(13): 1096-1102
Published online Sep 25, 2015. doi: 10.4253/wjge.v7.i13.1096
Hospitalization for esophageal achalasia in the United States
Daniela Molena, Benedetto Mungo, Miloslawa Stem, Anne O Lidor
Daniela Molena, Benedetto Mungo, Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Miloslawa Stem, Anne O Lidor, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Author contributions: All the authors equally contributed to this work.
Institutional review board statement: The study was exempt by the Johns Hopkins School of Medicine Institutional Review Board.
Conflict-of-interest statement: Daniela Molena is a speaker for Novadaq Corporation. The remaining authors have no disclosures.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anne O Lidor, MD, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 618, Baltimore, MD 21287, United States. alidor1@jhmi.edu
Telephone: +1-410-9550377 Fax: +1-410-6149866
Received: March 13, 2015
Peer-review started: March 16, 2015
First decision: April 10, 2015
Revised: May 2, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: September 25, 2015
Abstract

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 by significant mortality and morbidity.

Keywords: Esophageal achalasia, Outcomes, Myotomy

Core tip: We aimed to assess the outcomes of different treatments in patients hospitalized for esophageal achalasia in the United States. We queried the Nationwide Inpatient Sample database from 2003 to 2010. Patients admitted with a primary diagnosis of achalasia were divided into 3 groups, based on treatment, and compared. About half of the patients did not actually undergo a surgical procedure; yet, they had the highest mortality and lowest home discharge rate. Our data suggest that when achalasia has gone too far and previous treatments have been untimely or ineffective, patients may face non-negligible mortality and morbidity even with endoscopic treatment or supportive care.