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Readmission and Reintervention After Esophageal Myotomy: A Population-based Longitudinal Study of Patients with Achalasia.
Elan R. Witkowski*1, Mariam F. Eskander2, Jonathan F. Critchlow2, Sing Chau Ng2, Jennifer F. Tseng2, David W. Rattner1
1Surgery, Massachusetts General Hospital, Boston, MA; 2Surgery, Beth Israel Deaconess Medical Center, Boston, MA
Background:
Laparoscopic Heller myotomy (LHM) is the most commonly performed surgical procedure for achalasia. Achalasia is relatively uncommon, and most data published on operative outcomes come from single-institution series or inpatient databases. We hypothesized that true rates of readmission and reintervention may be higher than previously published reports.
Methods:
Data from the 2007-2011 HCUP Florida State Inpatient Databases (SID), Ambulatory Surgery and Services Databases (SASD), and Emergency Department Databases (SEDD) were queried and linked to provide longitudinal patient-level data. All patients aged 18-99 with a diagnosis of achalasia who underwent esophageal myotomy were identified using ICD9 codes. Postoperative outcomes including death, complications, discharge disposition, inpatient readmission, emergency department (ED) visits, reinterventions, and cost were quantified.
Results:
719 patients were identified who underwent inpatient myotomy. Median age was 55 (IQR 41-66), with an equal sex distribution. The majority had at least one comorbidity. Median LOS was 2 days (IQR 2-5). There were too few deaths or redo operations to report (<11). 97.2% of patients were discharged home (88.7% without services).
Revisits and inpatient readmissions were common. ED visits occurred in 8.2% within 30 days after discharge, and 13.1% by 90 days. Readmissions occurred in 7.8% within 30 days after discharge, and 11.5% by 90 days. When combined, these occurred in 15.4% of patients by 30 days, and 25.2% by 90 days. Within 90 days, only 5.1% had a repeat endoscopy and 2.5% had an endoscopic intervention. By 1 year, this rose to 14.9% and 6.7%. Beyond the cost of the index hospitalization, readmission or ED revisit within 30 days added an additional median cost ,625.
Conclusions:
In this longitudinal series examining a 100% sample of patients in Florida who underwent esophageal myotomy for achalasia, rates of death and reoperation were extremely low. While the rate of endoscopic reintervention remains low at 1 year, the rates of readmission and ED revisits add substantial cost and present a significant opportunity improvement. Further work to identify predictors of these events is ongoing.
| REVISITS AND READMISSIONS | | | Revisit to ED within 30 days | 8.2% | | Revisit to ED within 90 days | 13.1% | | | | | Inpatient readmission within 30 days | 7.8% | | Inpatient readmission within 90 days | 11.5% | | | | | Any revisit within 30 days (ED or IP or AS) | 15.4% | | Any revisit within 90 days (ED or IP or AS) | 25.2% | | | | | Median cost within 30 days (including any revisit: ED, IP, AS) | ,625 | | Median cost within 90 days (including any revisit: ED, IP, AS) | ,086 | | | | | SUBSEQUENT PROCEDURES | | | Endoscopy within 90 days | 5.1% | | Endoscopic intervention within 90 days | 2.5% | | | | | Endoscopy within 365 days | 14.9% | | Endoscopic intervention within 365 days | 6.7% |
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