title: Hospitalization for esophageal achalasia in the United States.
abstract: OBJECTIVE
  To assess the outcome of different treatments in patients admitted for esophageal achalasia in the United States.
  
  
  METHODS
  This is a retrospective analysis using the Nationwide Inpatient Sample over an 8-year period (2003-2010). Patients admitted with a primary diagnosis of achalasia were divided into 3 groups based on their treatment: (1) Group 1: patients who underwent Heller myotomy during their hospital stay; (2) Group 2: patients who underwent esophagectomy; and (3) Group 3: patients not undergoing surgical treatment. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), discharge destination and total hospital charges.
  
  
  RESULTS
  Among 27141 patients admitted with achalasia, nearly half (48.5%) underwent Heller myotomy, 2.5% underwent esophagectomy and 49.0% had endoscopic or other treatment. Patients in group 1 were younger, healthier, and had the lowest mortality when compared with the other two groups. Group 2 had the highest LOS and hospital charges among all groups. Group 3 had the highest mortality (1.2%, P < 0.001) and the lowest home discharge rate (78.8%) when compared to the other groups. The most frequently performed procedures among group 3 were esophageal dilatation (25.9%) and injection (13.3%). Among patients who died in this group the most common associated morbidities included acute respiratory failure, sepsis and aspiration pneumonia.
  
  
  CONCLUSIONS
  Surgery for achalasia carries exceedingly low mortality in the modern era; however, in complicated patients, even less invasive treatments are burdened by significant mortality and morbidity.
authors.affiliation: Daniela Molena, Benedetto Mungo, Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
authors.affiliation: Daniela Molena, Benedetto Mungo, Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.affiliation: Daniela Molena, Benedetto Mungo, Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors.forename: Miloslawa
authors.initials: M
authors.lastname: Stem
authors.affiliation: Daniela Molena, Benedetto Mungo, Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
keywords: Esophageal achalasia; Myotomy; Outcomes