RF24 | PSUN108 Inpatient and Readmission Outcomes Following Endoscopic Gastrectomy Versus Gastrojejunostomy in Patients with Morbid Obesity: A Nationwide Retrospective Analysis

Abstract

Abstract The prevalence of obesity has increased worldwide leading to an increase in associated comorbidities and mortality. Endoscopic procedures are emerging treatments for obesity. We aimed to compare the outcomes of two of these procedures. This was a retrospective cohort study involving adults above 18 years old with morbid obesity admitted for either endoscopic vertical sleeve gastrectomy (EVSG) or endoscopic gastrojejunostomy (EGJ) in the US in 2019. We extracted data from the Nationwide Readmissions Database (NRD) in 2019, coding done with the International Classification of Diseases Tenth Revision, Clinical Modification (ICD10-CM). The study included hospitalizations with morbid obesity as the principal discharge diagnosis for index admission using ICD code E6601 excluding December hospitalizations and trauma admissions. This group was divided into EVSG (ICD: 0DB64Z3) and EGJ (ICD: 0D164ZA). Using unique identifiers, we obtained the index hospitalization and one subsequent hospitalization involving the same patient within 30 days as readmission. Outcomes included inpatient mortality, length of stay (LOS), and total hospital costs (THC) of the index hospitalization. We compared the 30-day all-cause readmission rate (ACR), the top 10 reasons for readmission, and independent predictors of readmission. We used multivariate Cox regression analysis to calculate the adjusted hazard ratio (aHR) to identify the independent predictors of readmission. The threshold for statistical significance was a p-value of <0.05. The study included 162,670 hospitalizations, 70.6% EVSG, and 29.4% EGJ. The mean age in the EVSG group was 43.8 ±12.8, compared to 45.1 ±12.3 years. The mean Charlson Comorbidity Index (CCI) was higher in the EGJ group (0.9 vs 0.7, p<0.001). Hospitalizations for EVSG had a higher proportion in the highest income quartile (20.5 vs 16.3%). Inpatient mortality rate was 0.02%, EGJ had higher adjusted odds ratio (aOR) (0.05 vs 0.01%, aOR: 5.07, 95% CI: 2.08–12.35, p<0.001) adjusted for age groups and sex. The EGJ group also had a longer LOS (1.9 vs 1.6 days, p<0.001) and higher THC (15,199 vs 12,408 USD, p<0.001). The overall 30 ACR rate was 3.0%, with a higher rate following EGJ (4.5 vs 2.4%). "Other complications of bariatric procedure" was the top reason for readmission (11.1%), followed by dehydration (5.2%), sepsis from unspecified organism (3.2%). EGJ patients had a higher adjusted hazard ratio for readmission (aHR: 1.81, p<0.001). Independent predictors of readmission included private insurance compared to Medicare (aHR: 0.59, p<0.001), large bed-size compared to small (aHR: 0.61, p=0.002), comorbid CHF (aHR: 1.50, p <0.001), PVD (aHR: 1.49, p=0.007), COPD (aHR: 1.13, p=0.014), DM (aHR: 1.12, p=0.009), and CKD (aHR: 1.20, p<0.001). EGJ is associated with more mortality, THC, and LOS in the index admission and more 30-day all-cause readmission rates compared to EVSG. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:42 p.m. - 12:47 p.m.