Hospitalization for esophageal achalasia in the United States

Table 1 International Classification of Disease, ninth revision procedure and diagnosis codes used to determine surgical procedure categories and complications

	ICD-9 code
Achalasia	530
Heller1	427
Esophagectomy1	42.4, 42.41, 42.42, 42.5, 42.51-59, 42.6, 42.61-69
Esophageal cancer	150, 150.1, 150.2, 150.3, 150.4, 150.5, 150.8, 151
Complications
Pneumonia	481, 482.0-482.4, 482.8-482.9, 483, 484, 485, 486, 507.0, 482.40, 482.41. 482.42, 482.49
Urinary tract infection	997.5, 599.0-599.9
Shock/sepsis	998.0, 995.9, 995.90, 995.91, 995.92, 038
Pulmonary compromise	514, 518.4, 518.5, 518.81, 518.82

¹Indicates procedure codes. ICD-9: International Classification of Disease, ninth revision.

Table 2 Baseline demographic and clinical characteristics of patients among the three groups, Nationwide Inpatient Sample, 2003-2010 n (%)

	Total	Group 1	Group 2	Group 3	P
	31769	Heller 5567 (49.00)	Esophagectomy 785 (2.47)	Non-surgical 15417 (48.53)
Age, mean (median)	59 (59)	51.2 (51)	53.8 (54)	67.1 (72)	< 0.001
Age category					< 0.001
18-44	8041 (25.31)	5576 (35.82)	251(31.97)	2214 (14.36)
45-64	10554 (33.22)	6330 (40.66)	308 (39.24)	3916 (25.40)
65-74	4746 (14.94)	2254 (14.48)	141 (17.96)	2351 (15.25)
≥ 75	8428 (26.53)	1407 (9.04)	85 (10.83)	6936 (44.99)
Gender1					< 0.001
Male	14429 (45.73)	7883 (51.21)	371 (47.41)	6175 (40.17)
Female	17120 (54.27)	7510 (48.79)	412 (52.59)	9198 (59.83)
Race2					0.002
White	17663 (70.77)	8662 (71.64)	403 (65.96)	8598 (70.15)
Black	3662 (14.67)	1533 (12.68)	75 (12.27)	2054 (16.76)
Other	3633 (14.56)	1896 (15.68)	133 (21.77)	1604 (13.09)
Charlson score	0.63	0.34	0.48	0.93	0.036
0	21147 (64.53)	11681 (75.04)	508 (64.71)	7958 (51.62)	< 0.001
1	7390 (22.55)	3015 (19.37)	206 (26.24)	4169 (27.04)
≥ 2	4232 (12.91)	871 (5.59)	71 (9.05)	3290 (21.34)

¹Missing data for 220 patients;

²Missing data for 6811 patients.

Table 3 Most common procedure types for patients who underwent non-surgical treatment of achalasia

ICD-9 code	Procedure type	Group 3
		Non-surgical 15417
45.13 and 45.16	Esophagogastroduodenoscopy	65.15%
42.92	Dilation of esophagus	26.94%
99.57 and 99.29	Injection of therapeutic/prophylactic substance-including botulism antitoxin	17.32%
98.02	Removal of intraluminal foreign body from esophagus without incision	6.44%
43.11	Percutaneous endoscopic gastrostomy percutaneous transabdominal gastrostomy	5.73%
29.31	Cricopharyngeal myotomy	2.77%

ICD-9: International Classification of Diseases, ninth revision.

Table 4 Observed unadjusted rates of outcomes across the three patient groups, Nationwide Inpatient Sample, 2003-2010 n (%)

	Total	Group 1	Group 2	Group 3	P
	31769	Heller 15567 (49.00)	Esophagectomy 785 (2.47)	Non-surgical 15417 (48.53)
In-hospital mortality	206 (0.65)	16 (0.1)	15 (1.96)	180 (1.17)	< 0.001
Disposition
Home1	27916 (87.87)	15130 (97.19)	637 (81.15)	12149 (78.80)	< 0.001
Transfer2	3504 (11.03)	416 (2.67)	133 (16.89)	2955 (19.17)	< 0.001
Pneumonia	1959 (6.17)	509 (3.27)	150 (19.11)	1300 (8.43)	< 0.001
UTI	1462 (4.60)	311 (2.00)	50 (6.37)	1101 (7.14)	< 0.001
Shock/sepsis	171 (0.54)	50 (0.32)	46 (5.86)	75 (0.49)	< 0.001
Pulmonary compromise	813 (2.56)	241 (1.55)	245 (31.21)	327 (2.12)	< 0.001
Median LOS (d)	3	2	13	4	< 0.001
Median TOTCHG	$26299.41	$30118.12	$134670.40	$21175.23	< 0.001

¹Home is discharge to home with and without home health care;

²Transfer is discharge to short term hospital, skilled nursing facility, intermediate care and other type of facilities. LOS: Length of hospital stay; TOTCHG: Total hospital charges; UTI: Urinary tract infection.

Table 5 Adjusted odds ratios of outcomes and complications for the non-surgical group (in comparison to the Heller group)

	OR	P	95%CI
In-hospital mortality	4.73	0.03	1.16-19.31
Disposition
Home	0.24	< 0.001	0.19-0.31
Transfer	3.76	< 0.001	2.85-4.97
Pneumonia	1.91	< 0.001	1.42-2.58
Urinary tract infection	2.31	< 0.001	1.67-3.18
Shock/sepsis	1.18	0.726	0.47-2.97
Pulmonary compromise	0.83	0.413	0.54-1.29

All the analyses were adjusted for age, gender, and Charlson Index score.

Table 6 Adjusted odds ratios of outcomes and complications for the esophagectomy group (in comparison to the non-surgical group)

	OR	P	95%CI
In-hospital mortality	7.28	0.002	2.06-25.79
Disposition
Home	0.54	0.009	0.35-0.86
Transfer	1.84	0.010	1.16-2.94
Pneumonia	3.68	< 0.001	2.40-5.64
Urinary tract infection	1.28	0.507	0.62-2.67
Shock/sepsis	16.53	0.001	6.36-42.96
Pulmonary compromise	37.97	< 0.001	22.85-63.07

All the analyses were adjusted for age, gender, and Charlson Index score.