Management of dysphagia in esophageal cancer (EC): A population-based study.

Abstract

100 Background: Dysphagia is associated with significant morbidity in patients (pts) with EC. Our study is the first report of national trends in hospitalizations due to EC and dysphagia, with special emphasis on nutritional interventions and related outcomes. Methods: The analysis included all adult inpatients with EC and dysphagia in the Nationwide Inpatient Sample from 2002-2012. We examined temporal trends and performed multivariate analysis for key outcomes; controlling for demographics, hospital factors, comorbidities, and interventions. Results: Among 509,593 hospitalizations involving pts with EC, 12,205 were related to dysphagia. The percentage of all hospitalizations for EC (1.52 vs. 3.28%; p < 0.001) and EC with dysphagia (0.0025 vs. 0.0059%, p < 0.001) doubled over the study period. Among all pts with EC, inpatient mortality for EC with dysphagia was 4.39%. Mean length of stay (LOS) and cost of hospitalization were 8.1 days and $15,171, respectively. Feeding tube (FT) placement was performed in 27 % of pts, esophageal stenting in 13% and peripheral nutrition (TPN) was used in 11%. The incidence of stent placement was higher in urban teaching hospitals (33%) vs. urban non-teaching (21%) or rural nonteaching hospitals (17%). On multivariate analysis, placement of FT and stents was associated with comparable inpatient mortality and LOS, but TPN was associated with higher mortality (OR 2.25; 95% CI 1.93, 2.62) and prolonged LOS (+3.4 days, CI 2.79, 3.97). Compared to FT, stents (+ $3,042, CI 432, 5,652) and TPN (+ $10,573, CI 8,766, 12,380) resulted in higher cost of hospitalization. More pts developed sepsis on TPN (6.1%) compared to FT (2.5%) or stents (1.8%). Inpatient mortality associated with any nutritional intervention was lower in urban teaching compared to rural nonteaching hospitals (0.71; CI 0.65, 0.79). Conclusions: Hospitalizations for EC and dysphagia are increasing and mortality in such pts is high and multifactorial. TPN is associated with sepsis and mortality in this setting. Nutritional intervention practices and possibly outcomes vary significantly based on hospital type. This finding should be further explored to better define the most appropriate interventions and treatment setting for this patient population.