2119 - Radiation Enteritis Requiring Hospitalization: National Trends, GI Management Patterns and Disparities

Purpose/Objective(s): Radiation enteritis is a significant complication of abdominal/pelvic radiotherapy requiring gastroenterological intervention. National data on hospitalization outcomes, GI management patterns, and care disparities remain limited. We characterized the national burden of radiation enteritis hospitalizations, identified mortality predictors, and evaluated disparities in GI management.

Materials/Methods: Using the National Inpatient Sample 2019-2022, we identified adult hospitalizations with radiation enteritis. Weighted national estimates were generated using NIS survey design. Multivariable logistic regression evaluated predictors of in-hospital mortality adjusting for demographics, comorbidities, insurance, income, and hospital characteristics. Secondary analyses examined predictors of endoscopy and surgical intervention.

Results: We identified 22,415 weighted hospitalizations. The cohort was predominantly White (75.9%) and Medicare-insured (64.6%). Overall mortality was 3.3%, median LOS 5 days, and median charges $47,069. Common complications included dehydration (59.3%), anemia (35.3%), malnutrition (31.4%), and intestinal obstruction (26.7%). GI management included surgery (22.9%), transfusion (14.7%), endoscopy (7.8%), and TPN (6.6%). An underlying cancer was coded in 55.8%. Hospitalization volume declined (6,690 in 2019 to 4,850 in 2022; p=0.06) while charges increased (p=0.03). Strongest mortality predictors were self-pay insurance (OR 7.03, 95% CI 4.58-10.80), malnutrition (OR 2.67, 2.27-3.14), coagulopathy (OR 2.55, 2.11-3.08), and metastatic disease (OR 2.46, 1.98-3.07). Lowest income quartile independently predicted mortality (OR 1.49, 1.18-1.89). Medicaid was associated with reduced endoscopy (OR 0.62, 0.50-0.77), rural hospitals had lower surgical rates (OR 0.52, 0.44-0.60), and Black patients were less likely to receive surgery (OR 0.87, 0.77-0.98) while carrying higher malnutrition (39.2% vs 31.2%) and anemia burdens (48.1% vs 32.9%).

Conclusion: Radiation enteritis hospitalizations carry 3.3% mortality with frequent GI complications and significant costs. Uninsured patients face 7-fold higher mortality. Disparities in endoscopy access, surgical intervention, and comorbidity burden highlight the need for equitable, multidisciplinary GI supportive care following radiotherapy.