3706 - Failure to Rescue in Radiation Enteritis: National Patterns of GI Management, Hospital-Level Variation, and Socioeconomic Disparities

Purpose/Objective(s): Radiation enteritis is a complication of abdominal/pelvic radiotherapy that may require endoscopy, nutritional support, and surgery. We hypothesized that socioeconomic disparities exist in failure-to-rescue (FTR) and GI management among patients hospitalized for radiation enteritis.

Materials/Methods: Using the NIS (2019-2022), we identified adult hospitalizations with radiation enteritis (K52.0). Primary outcome was FTR (in-hospital mortality). Secondary outcomes included endoscopy, surgery, TPN, and transfusion. Multivariable logistic regression identified predictors of FTR and endoscopy use, adjusting for demographics, comorbidities, complications, insurance, income, and hospital characteristics.

Results: We identified 22,415 weighted hospitalizations (4,483 unweighted). FTR was 3.3%, median LOS 5 days [Interquartile range (IQR) 3-9], median charges $47,069. GI management: surgery 22.9%, transfusion 14.7%, endoscopy 7.8%, TPN 6.6%. Among deceased: sepsis 57.3% vs 12.2% survivors, Acute Kidney Injury (AKI) 60.7% vs 23.7%, respiratory failure 60.7% vs 6.6%, malnutrition 52.0% vs 30.7% (all p<0.001). Endoscopy functioned as triage: 42.7% proceeded to surgery vs 21.2% without, with higher bowel resection (35.6% vs 17.9%) and colostomy (9.4% vs 2.9%). Self-pay had 9.6% FTR vs 2.2% privately insured (adjusted OR 7.86, 5.01-12.34, p<0.001). Medicaid predicted higher FTR (OR 1.94, 1.34-2.82) and reduced endoscopy access (OR 0.62, 0.50-0.78; both p<0.001). Lowest income quartile predicted FTR (OR 1.44, 1.12-1.85, p=0.005). Rural hospitals had lower surgery rates (15.8% vs 23.6% urban teaching, p=0.004). Strongest FTR predictors: sepsis (OR 9.10, 7.66-10.82), metastatic disease (OR 2.47), GI hemorrhage (OR 2.29), coagulopathy (OR 2.09), malnutrition (OR 1.88; all p<0.001).

Conclusion: FTR in radiation enteritis is driven by sepsis, organ failure, and malnutrition complications amenable to early GI consultation. Endoscopy serves as triage, with nearly half requiring surgical escalation. Uninsured patients face 8-fold higher mortality and Medicaid patients have 38% lower endoscopy access. These findings support proactive GI consultation and standardized endoscopic evaluation in radiation toxicity pathways, particularly at under-resourced facilities.