# A Decade of Change: National Trends in Management and Outcomes of Achalasia Hospitalizations in the United States

## TL;DR

Over the past decade in the U.S., the treatment of achalasia has shifted toward POEM, but hospitalization costs and complications have increased.

## Contribution

This study provides the first nationwide analysis of trends and outcomes in achalasia hospitalizations from 2011 to 2022.

## Key findings

- POEM use increased from 5.8% in 2016 to 10.3% in 2022, while LHM and esophagectomy rates declined.
- Hospitalization costs rose by 3.18% annually, and mortality rates increased despite stable length of stay.
- Higher patient comorbidity was linked to increased complications and mortality.

## Abstract

Achalasia is a rare esophageal motility disorder managed through various interventions, including laparoscopic Heller myotomy (LHM), pneumatic dilation (PD), and, more recently, per‐oral endoscopic myotomy (POEM). Over the past decade, there has been a shift toward POEM, though nationwide hospitalization trends and outcomes remain understudied.

We conducted a retrospective trend analysis using the National Inpatient Sample (NIS) database from 2011 to 2022. Adult patients hospitalized with a primary diagnosis of achalasia were identified using ICD‐9/10‐CM codes. Trends in management strategies (LHM, POEM, PD, and esophagectomy), hospitalization outcomes, and complications were analyzed. Multivariable regression adjusted for patient and hospital characteristics was also performed to compare outcomes between 2011 and 2022.

A total of 63,420 weighted achalasia‐related admissions were identified. The use of LHM declined significantly (AAPC −4.66%, p < 0.001), while POEM use rose from 5.8% in 2016 to 10.3% in 2022 (AAPC 7.76%, p = 0.049). Hospitalization costs increased annually by 3.18% (p < 0.001), while the length of stay remained stable. Mortality rates rose over time; however, there was no difference after adjusting for patient‐related factors. Adjusted analyses revealed increased odds of POEM in 2022 (aOR 1.87), decreased odds of LHM and esophagectomy, and higher odds of respiratory complications.

From 2011 to 2022, there has been a clear shift toward the use of POEM for the inpatient management of achalasia. However, worsening patient comorbidity profiles have driven increased complications and mortality and may contribute to increasing costs. Early intervention and broader POEM adoption may optimize future outcomes.

From 2011 to 2022, inpatient management of achalasia declined while hospitalization costs rose. POEM utilization increased, accompanied by declines in LHM and esophagectomy rates. As patients presented with higher comorbidity burdens, both mortality and respiratory complications showed an upward trend.