Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 3, June 2023, pages 141-148

Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy

Figure 1. Achalasia patients requiring hospitalizations after per-oral endoscopic myotomy (POEM) in the United States from 2016 to 2019.

Figure 2. Geographical distribution of achalasia patients requiring hospitalizations after per-oral endoscopic myotomy (POEM) in the United States between 2016 and 2019.

**Table 1.** Hospitalization Characteristics for Patients With Achalasia That Underwent POEM in the Unites States From 2016 to 2019
Variable	Years
CCI: Charlson Comorbidity Index; POEM: per-oral endoscopic myotomy.
Total number of POEM	380	570	445	490	1,885
Mean age (years) ± standard error	54.2 ± 1.4	56.8 ± 1.5	59.6 ± 1.9	59.3 ± 2.0	57.6 ± 0.9
Age group distribution (years)
18 - 34	80 (21.1%)	105 (18.4%)	40 (9.0%)	60 (12.2%)	285 (15.1%)
35 - 49	75 (19.7%)	80 (14.0%)	75 (16.9%)	75 (15.3%)	305 (16.2%)
50 - 64	115 (30.3%)	155 (27.2%)	155 (34.8%)	115 (23.5%)	540 (28.7%)
65 - 79	90 (23.7%)	195 (34.2%)	115 (25.8%)	200 (40.8%)	600 (31.8%)
≥ 80	20 (5.3%)	35 (6.1%)	60 (13.5%)	40 (8.2%)	155 (8.2%)
Gender
Male	185 (48.7%)	270 (47.4%)	220 (49.4%)	260 (53.1%)	935 (49.6%)
Female	195 (51.3%)	300 (52.6%)	225 (50.6%)	230 (46.9%)	950 (50.4%)
Race
White	275 (76.4%)	380 (69.7%)	270 (62.1%)	320 (66.7%)	1,245 (68.4%)
Black	45 (12.5%)	90 (16.5%)	75 (17.2%)	60 (12.5%)	270 (14.8%)
Hispanic	30 (8.3%)	45 (8.3%)	50 (11.5%)	50 (10.4%)	175 (9.6%)
Asian	< 11 (1.4%)	0 (0.00%)	15 (3.5%)	30 (6.3%)	50 (2.8%)
Others	< 11 (1.4%)	30 (5.5%)	25 (5.8%)	20 (4.2%)	80 (4.4%)
CCI
CCI = 0	230 (60.5%)	350 (61.4%)	220 (49.4%)	260 (53.1%)	1,060 (56.2%)
CCI = 1	55 (14.5%)	130 (22.8%)	120 (27.0%)	150 (30.6%)	455 (24.1%)
CCI = 2	50 (13.2%)	40 (7.0%)	50 (11.2%)	40 (8.2%)	180 (9.6%)
CCI ≥ 3	45 (11.8%)	50 (8.8%)	55 (12.4%)	40 (8.2%)	190 (10.1%)
Hospital region
Northeast	135 (35.5%)	205 (36.0%)	120 (27.0%)	175 (35.7%)	635 (33.7%)
Midwest	125 (32.9%)	135 (23.7%)	85 (19.1%)	60 (12.2%)	405 (21.5%)
South	80 (21.1%)	165 (29.0%)	170 (38.2%)	195 (39.8%)	610 (32.4%)
West	40 (10.5%)	65 (11.4%)	70 (15.7%)	60 (12.2%)	235 (12.5%)
Hospital bed size
Small	< 11 (1.3%)	0 (0.0%)	15 (3.4%)	25 (5.1%)	45 (2.4%)
Medium	25 (6.6%)	95 (16.7%)	45 (10.1%)	50 (10.2%)	215 (11.4%)
Large	350 (92.1%)	475 (83.3%)	385 (86.5%)	415 (84.7%)	1,625 (86.2%)
Hospital location and teaching status
Rural	< 11 (1.3%)	< 11 (0.9%)	0 (0.0%)	0 (0.0%)	< 11 (0.5%)
Urban nonteaching	15 (4.0%)	25 (4.4%)	< 11 (1.1%)	15 (3.1%)	60 (3.2%)
Urban teaching	360 (94.7%)	540 (94.7%)	440 (98.9%)	475 (96.9%)	1,815 (96.3%)
Expected primary payer
Medicare	140 (36.8%)	250 (43.9%)	205 (46.1%)	230 (46.9%)	825 (43.8%)
Medicaid	65 (17.1%)	55 (9.7%)	35 (7.9%)	60 (12.2%)	215 (11.4%)
Private	165 (43.4%)	230 (40.4%)	170 (38.2%)	175 (35.7%)	740 (39.3%)
Self-pay	< 11 (1.3%)	< 11 (1.8%)	20 (4.5%)	15 (3.2%)	50 (2.7%)
Other	< 11 (1.3%)	25 (4.4%)	15 (3.4%)	< 11 (2.0%)	55 (2.9%)
Median household income (quartile)
First (0 - 25th)	100 (27.0%)	105 (18.4%)	125 (28.1%)	110 (23.2%)	440 (23.7%)
Second (26th - 50th)	90 (24.3%)	165 (29.0%)	145 (32.6%)	110 (23.2%)	510 (27.4%)
Third (51st - 75th)	75 (20.3%)	150 (26.3%)	70 (15.7%)	100 (21.1%)	395 (21.2%)
Fourth (76th - 100th)	105 (28.4%)	150 (26.3%)	105 (23.6%)	155 (32.6%)	515 (27.7%)

Table 1. Hospitalization Characteristics for Patients With Achalasia That Underwent POEM in the Unites States From 2016 to 2019

Variable

Years

2016

2017

2018

2019

2016 - 2019 (overall)

CCI: Charlson Comorbidity Index; POEM: per-oral endoscopic myotomy.

Total number of POEM

380

570

445

490

1,885

Mean age (years) ± standard error

54.2 ± 1.4

56.8 ± 1.5

59.6 ± 1.9

59.3 ± 2.0

57.6 ± 0.9

Age group distribution (years)

18 - 34

80 (21.1%)

105 (18.4%)

40 (9.0%)

60 (12.2%)

285 (15.1%)

35 - 49

75 (19.7%)

80 (14.0%)

75 (16.9%)

75 (15.3%)

305 (16.2%)

50 - 64

115 (30.3%)

155 (27.2%)

155 (34.8%)

115 (23.5%)

540 (28.7%)

65 - 79

90 (23.7%)

195 (34.2%)

115 (25.8%)

200 (40.8%)

600 (31.8%)

≥ 80

20 (5.3%)

35 (6.1%)

60 (13.5%)

40 (8.2%)

155 (8.2%)

Gender

Male

185 (48.7%)

270 (47.4%)

220 (49.4%)

260 (53.1%)

935 (49.6%)

Female

195 (51.3%)

300 (52.6%)

225 (50.6%)

230 (46.9%)

950 (50.4%)

Race

White

275 (76.4%)

380 (69.7%)

270 (62.1%)

320 (66.7%)

1,245 (68.4%)

Black

45 (12.5%)

90 (16.5%)

75 (17.2%)

60 (12.5%)

270 (14.8%)

Hispanic

30 (8.3%)

45 (8.3%)

50 (11.5%)

50 (10.4%)

175 (9.6%)

Asian

< 11 (1.4%)

0 (0.00%)

15 (3.5%)

30 (6.3%)

50 (2.8%)

Others

< 11 (1.4%)

30 (5.5%)

25 (5.8%)

20 (4.2%)

80 (4.4%)

CCI

CCI = 0

230 (60.5%)

350 (61.4%)

220 (49.4%)

260 (53.1%)

1,060 (56.2%)

CCI = 1

55 (14.5%)

130 (22.8%)

120 (27.0%)

150 (30.6%)

455 (24.1%)

CCI = 2

50 (13.2%)

40 (7.0%)

50 (11.2%)

40 (8.2%)

180 (9.6%)

CCI ≥ 3

45 (11.8%)

50 (8.8%)

55 (12.4%)

40 (8.2%)

190 (10.1%)

Hospital region

Northeast

135 (35.5%)

205 (36.0%)

120 (27.0%)

175 (35.7%)

635 (33.7%)

Midwest

125 (32.9%)

135 (23.7%)

85 (19.1%)

60 (12.2%)

405 (21.5%)

South

80 (21.1%)

165 (29.0%)

170 (38.2%)

195 (39.8%)

610 (32.4%)

West

40 (10.5%)

65 (11.4%)

70 (15.7%)

60 (12.2%)

235 (12.5%)

Hospital bed size

Small

< 11 (1.3%)

0 (0.0%)

15 (3.4%)

25 (5.1%)

45 (2.4%)

Medium

25 (6.6%)

95 (16.7%)

45 (10.1%)

50 (10.2%)

215 (11.4%)

Large

350 (92.1%)

475 (83.3%)

385 (86.5%)

415 (84.7%)

1,625 (86.2%)

Hospital location and teaching status

Rural

< 11 (1.3%)

< 11 (0.9%)

0 (0.0%)

< 11 (0.5%)

Urban nonteaching

15 (4.0%)

25 (4.4%)

< 11 (1.1%)

15 (3.1%)

60 (3.2%)

Urban teaching

360 (94.7%)

540 (94.7%)

440 (98.9%)

475 (96.9%)

1,815 (96.3%)

Expected primary payer

Medicare

140 (36.8%)

250 (43.9%)

205 (46.1%)

230 (46.9%)

825 (43.8%)

Medicaid

65 (17.1%)

55 (9.7%)

35 (7.9%)

60 (12.2%)

215 (11.4%)

Private

165 (43.4%)

230 (40.4%)

170 (38.2%)

175 (35.7%)

740 (39.3%)

Self-pay

< 11 (1.3%)

< 11 (1.8%)

20 (4.5%)

15 (3.2%)

50 (2.7%)

Other

< 11 (1.3%)

25 (4.4%)

15 (3.4%)

< 11 (2.0%)

55 (2.9%)

Median household income (quartile)

First (0 - 25th)

100 (27.0%)

105 (18.4%)

125 (28.1%)

110 (23.2%)

440 (23.7%)

Second (26th - 50th)

90 (24.3%)

165 (29.0%)

145 (32.6%)

110 (23.2%)

510 (27.4%)

Third (51st - 75th)

75 (20.3%)

150 (26.3%)

70 (15.7%)

100 (21.1%)

395 (21.2%)

Fourth (76th - 100th)

105 (28.4%)

150 (26.3%)

105 (23.6%)

155 (32.6%)

515 (27.7%)

**Table 2.** Trends of Outcomes for Patients With Achalasia That Underwent POEM in the Unites States From 2016 to 2019
Outcomes	Years
ICF: intermediate care facility; POEM: per-oral endoscopic myotomy; SNF: skilled nursing facility; USD: United States Dollars.
Disposition
Routine (home)	340 (89.5%)	495 (86.8%)	390 (87.6%)	440 (89.8%)	1,665 (88.3%)
Transfer to short-term hospital	0 (0.0%)	10 (1.8%)	< 11 (1.1%)	< 11 (1.0%)	20 (1.1%)
Transfer to another type of facility (SNF and ICF)	20 (5.3%)	20 (3.5%)	20 (4.5%)	20 (4.1%)	80 (4.2%)
Home health care	15 (4.0%)	45 (7.9%)	25 (5.6%)	25 (5.1%)	110 (5.8%)
Discharge against medical advice	< 11 (1.3%)	0 (0.00%)	< 11 (1.1%)	0 (0.00%)	< 11 (0.5%)
Inpatient mortality	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Length of stay (days)	4.0	3.7	3.9	3.2	3.7
Total healthcare charge (USD)	52,057	75,240	67,520	65,109	66,151
Complications
Major post-procedural hemorrhage	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Esophageal perforation	< 11 (1.3%)	< 11 (0.9%)	< 11 (1.1%)	< 11 (2.0%)	25 (1.3%)
Post-procedure sepsis	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Post-procedure pneumonia	< 11 (1.3%)	0 (0.0%)	< 11 (1.1%)	< 11 (1.0%)	15 (0.8%)

Table 2. Trends of Outcomes for Patients With Achalasia That Underwent POEM in the Unites States From 2016 to 2019

Outcomes

Years

2016

2017

2018

2019

2016 - 2019 (overall)

ICF: intermediate care facility; POEM: per-oral endoscopic myotomy; SNF: skilled nursing facility; USD: United States Dollars.

Disposition

Routine (home)

340 (89.5%)

495 (86.8%)

390 (87.6%)

440 (89.8%)

1,665 (88.3%)

Transfer to short-term hospital

0 (0.0%)

10 (1.8%)

< 11 (1.1%)

< 11 (1.0%)

20 (1.1%)

Transfer to another type of facility (SNF and ICF)

20 (5.3%)

20 (3.5%)

20 (4.5%)

20 (4.1%)

80 (4.2%)

Home health care

15 (4.0%)

45 (7.9%)

25 (5.6%)

25 (5.1%)

110 (5.8%)

Discharge against medical advice

< 11 (1.3%)

0 (0.00%)

< 11 (1.1%)

0 (0.00%)

< 11 (0.5%)

Inpatient mortality

0 (0.0%)

Length of stay (days)

4.0

3.7

3.9

3.2

3.7

Total healthcare charge (USD)

52,057

75,240

67,520

65,109

66,151

Complications

Major post-procedural hemorrhage

0 (0.0%)

Esophageal perforation

< 11 (1.3%)

< 11 (0.9%)

< 11 (1.1%)

< 11 (2.0%)

25 (1.3%)

Post-procedure sepsis

0 (0.0%)

Post-procedure pneumonia

< 11 (1.3%)

0 (0.0%)

< 11 (1.1%)

< 11 (1.0%)

15 (0.8%)