Kandlakunta, Harika

INTRODUCTION: Esophageal cancer accounts for 1% of cancers diagnosed in the United States and the seventh most common cause of cancer-related mortality among men in the United States, with a 5-year survival rate of 19%. With an estimated $1.5 billion in direct medical costs in 2010, we look at ED utilization by this group of patients and analyze the economic burden and trends in ED visits and inpatient admissions over a 9-year period METHODS: The Nationwide Emergency Department Sample (NEDS; 2006-2014) was interrogated to identify patients with a primary diagnosis of esophageal cancer (ICD-9 CM code). The yearly incidence of ED visits, rates of hospitalization, length of stay (LOS), and total charges associated with ED or subsequent inpatient stays were assessed. As secondary analysis, survey logistic regression model was used to determine predictors of hospitalization. RESULTS: A total of 46,431 esophageal cancer-related ED visits were identified during this time period. Overall, early readmission visits increased overall from 6,295 in 2006 to a peak of 6,837 in 2014. The mean ED charges per visit, adjusted to inflation increased significantly from $1,401 in 2006 to $3,168 in 2014, while the mean total charges incurred by patients who were admitted to the hospital also increased from $41,009 in 2006 to $61,809 in 2014. Hospitalization rates decreased from 83.5% in 2006 to 78.8% in 2014 but in-hospital deaths decreased from 11.4% in 2006 to 8.7% in 2014. The average LOS in the hospitals decreased from 7.8 to 7.2 days. CONCLUSION: Increasing ED visits and charges associated with esophageal cancer are concerning. While hospitalization rates are slightly decreased during this 9-year period, there is an alarming uptrend in mortality rates which needs to be explored further. The results of our study suggest that further exploring factors that are associated with the recent upsurge in mortality may lead to the development of interventions that will significantly reduce in-hospital deaths.