The Influence of Psychiatric Factors on Healthcare Resource Utilization in Patients with Gastroparesis: A National Population Based Study

Introduction: Gastroparesis is a debilitating condition characterized by delayed gastric emptying, resulting in various gastrointestinal symptoms. Patients with gastroparesis frequently experience comorbid psychiatric disorders, which negatively impact the quality of life and are likely influenced by brain-gut network dysfunction. We aimed to characterize the longitudinal effect of comorbid anxiety, depression, or bipolar disorder on healthcare resource utilization in adults primarily hospitalized with a diagnosis of gastroparesis. Methods: We queried the 2016-2019 National Inpatient Sample, the largest all-payer inpatient hospital data from Healthcare Cost and Utilization Project (NIS-HCUP). Using ICD-10 code F31.84, we identified patients aged ≥ 18 years hospitalized with an index diagnosis of gastroparesis. The cohort was divided into patients with and without comorbid psychiatric mood disorders including depression, anxiety, and bipolar spectrum disorders. The chi-square test and ANOVA test were used for categorical and continuous data, respectively. Results: During the study period, a total of 9453 patients were identified who were hospitalized with a primary diagnosis of gastroparesis and 4285 (45.3 %) had a concurrent diagnosis of comorbid psychiatric mood disorders. Baseline characteristics are depicted in Table 1. Patients with comorbid psychiatric mood disorders had a higher mean Elixhauser comorbidity index (3.6 ± 1.8 vs 2.9 ± 1.8, P < 0.001) and had a higher length of hospital stay (OR 1.013, CI:1.010 -1.017, P < 0.001) after adjusting for comorbidities. In-hospital frequency of EGD procedure, and total hospitalization cost, however, were not significantly different between the groups. Conclusion: Patients hospitalized with gastroparesis that carry a concurrent psychiatric mood disorder seem to require longer hospital stays. Despite this difference, however, our analysis did not reveal any significant disparities in terms of in-hospital EGD procedures or overall hospitalization costs. These results highlight that all patients hospitalized with gastroparesis, regardless of concurrent psychiatric mood disorder, may benefit from more holistic interventions such as psychosocial therapy to help decrease symptom severity and improve quality of life. Further studies are warranted to elucidate the potential benefits and effectiveness of incorporating psychosocial interventions into the overall care plan for hospitalized gastroparesis patients. Table 1. - Baseline demographic characteristics, comorbidities, and hospital oucomes in patients with gastroparesis Variables Gastroparesis with psychiatric mood disorder Gastroparesis without psychiatric mood disorder P-value Number (%) 4285 (45.3 %) 5168 (54.7 %) Age (years): mean (SD) 47.3 (15.8) 49.5 (17.6) < 0.001 Gender < 0.001 Male 685 (16 %) 1430 (27.7 %) Female 3598 (84 %) 3737 (72.3 %) Age group < 0.001 18-34 1000 (23.3 %) 1169 (22.6 %) 35-49 1468 (34.3 %) 1551 (30.0 %) 50-64 1183 (27.6 %) 1340 (25.9 %) 65-79 508 (11.9 %) 792 (15.3 %) > = 80 126 (2.9 %) 316 (6.2 %) Race: < 0.001 White 3199 (74.6 %) 3123 (60.4 %) Black 569 (13.3 %) 1199 (23.2 %) Others 516 (12.1 %) 846 (16.4 %) Insurance status 0.003 Medicare 1767 (41.2 %) 2069 (40 %) Medicaid 971 (22.7 %) 1070 (20.7 %) Private 1271 (29.7 %) 1618 (31.3 %) Self-pay 162 (3.8 %) 259 (5.0 %) Other 109 (2.5 %) 148 (2.9 %) Comorbidities Heart failure 273 (6.4 %) 442 (8.6 %) < 0.001 Valvular disease 104 (2.4 %) 141 (2.7 %) 0.364 Hypertension 1970 (46.0 %) 2507 (48.5 %) 0.015 Diabetes Mellitus 504 (11.8 %) 972 (18.8 %) < 0.001 Hypothyroidism 713 (6.6 %) 563 (10.9 %) < 0.001 Renal failure 407 (9.5 %) 788 (15.3 %) < 0.001 Liver disease 340 (7.4 %) 334 (6.5 %) 0.006 Peptic ulcer disease 158 (3.7 %) 214 (4.2 %) 0.265 Coagulopathy 175 (4.1 %) 202 (3.9 %) 0.673 Obesity 697 (6.3 %) 634 (12.3 %) < 0.001 Elixhauser comorbidity score mean (SD) 3.6 ± 1.8 2.9 ± 1.8 < 0.001 Outcomes Length of stay (days): median (IQR) 4 (2-6) 3 (2-6) < 0.001 Total hospitalization cost (in dollars): mean (SD) 45081 (826) 45115 (904) 0.978 EGD Procedures, n (%) 492 (11.5 %) 603 (11.7 %) 0.796