Introduction: Esophageal stricture or stenosis (ESS) requires repeated endoscopic dilations (EsoD) or more advanced interventions to maintain esophageal patency. Unfortunately, restenosis leads to recurrent, costly, and unplanned hospital stays. In this study, we aimed to examine the burden and factors associated with readmissions for recurrent ESS. In addition, we also aimed to create a tool to stratify risk of readmission for ESS. Methods: National Readmissions Database (NRD) was interrogated to identify index hospital stays with EsoD (ICD-42.92) for ESS (ICD-9, 530.3, 530.0) in the first 6 months of 2014. Information about demographics, hospital factors, costs, comorbidities and procedural details was obtained. Time to first readmission for ESS was demonstrated using Kaplan-Meier (KM) curve and smoothed hazard estimates. Stepwise cox-regression regression analysis was performed to identify factors associated with first readmission associated with ESS. Point-estimates were used to develop a risk score, and subsequently risk deciles. ROC analysis (and internal validation from bootstrap resampling) was performed to assess the predictive ability. Results: After N=5826 index admissions for EsoD + ESS, 45% were readmitted within 6months (21% in ≤30days). Readmissions for ESS resulted in average cost of $107,851 per patient per 6 months. Time to first readmission and time-associated risk was demonstrated (Figure 1a,1b). In the multivariate analysis, increasing age, private insurance, discharge to a rehabilitation facility, and performing dilation ≤2 days of index hospital admission were protective against readmission for ESS. Requiring home health services, esophageal cancer, repeat EsoD in index admission, nutritional deficiencies, and number of chronic conditions increased risk of readmission for ESS (Table 1). ROC analysis yielded area under the curve of 0.63 (95%CI: 0.61, 0.64). The difference in actual readmission rate between the highest and lowest risk deciles as predicted by the model was +21% (30day) and +39% (6month) (Figure 2).350_A Figure 1. Kaplan-Meier curve shows cumulative incidence ratio from the time of discharge from index hospitalization to first readmission for ESS. Figure1b- Smoothed hazard function curve shows hazard of readmission after discharge from index hospitalization. As seen in this hazard plot, patients who had EsoD for ESS were at the highest risk during the first month after discharge with a steep decline in risk thereafter.350_B Figure 2. Forward selection automated stepwise Cox-regression analysis (p value for entry was 0.05) was performed. Additional factors that were assessed to not meet the entry criteria include: gender, weekend admission, elective nature of admission, median income associated with patiet’s zip code of residence, tobacco use, alcohol use, nausea/vomiting, abdominal pain, dysphagia, candadal esophagitis, non-eosinophilic/eosinophilic esophagitis, esophageal ulcrs, septic shock, esphagomyomectomy, and stricture repair surgery.Conclusion: This study showed substantial costs and readmission rates due to recurrent ESS. We have developed a risk-stratification tool that can be programmed into patient electronic medical record (EMR) to identify those at highest risk of readmission for recurrent ESS. Close outpatient follow up with planned outpatient EsoD or other interventions may be considered in patients at high risk of unplanned readmissions.350_C Figure 3. Demonstrates percent of patients readmitted for recurrent ESS at 1, 3, and 6 months after discharge from index hospital stay based on risk-stratified deciles predicted by the multivariate model.