A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach

Abstract

Large-scale, population-based analyses of the demographics, management, and healthcare resource utilization of patients with an intrathoracic stomach are largely unknown, an issue which has become more important with the aging of the population. Our objective was to understand the magnitude of the problem and to assess clinical outcomes and hospital costs in elective and emergent admissions of patients with an intrathoracic stomach in a large population-based study. The New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was queried for primary ICD-9-CM codes 553.3 and 552.3 in patients 18 years or older; 4858 hospital admissions were identified over a 5-year period (2002-2006). Database variables included age, gender, race, type of admission, operative intervention, in-hospital mortality, length of stay, and cost. Approximately 1000 patients are admitted to the hospital each year with primary diagnosis of intrathoracic stomach, an estimated 52 per 1 million of the population in New York State. Over half of those (53%) were emergent admissions. Interestingly, the majority of emergent admissions (66%) were discharged before any surgical intervention. Patients admitted emergently were older (68.0 vs. 62.1 years, p < 0.0001) and more likely African-American (12% vs. 6%, p < 0.0001). Compared to elective admissions, emergent admissions had higher mortality (2.7% vs. 1.2%, p < 0.001), longer length of stay (LOS) (7.3 vs. 4.9 days, p < 0.0001), and higher cost ($28,484 vs. $24,069, p < 0.001). Among patients who underwent surgery, emergent admissions had higher mortality (5.1% vs. 1.1%, p < 0.0001), greater LOS (13.1 vs. 4.9 days, p < 0.0001), and higher costs ($55,460 vs. $24,760, p < 0.0001). Multivariate regression analysis demonstrated age, emergent presentation, and operative admission as independent predictors for hospital mortality, LOS, and cost (p < 0.0001). Strikingly, more than half of admissions for intrathoracic stomach were emergent. Emergent admissions had higher mortality, longer LOS, and higher cost than elective admissions. These data support consideration of early elective repair.