P0593 - The Effect of Intubation Timing on Mortality and Complications in Patients With Esophageal Varices

Daniel Basta, MD¹, Tony Elias, DO², Animita Saha, MD³, Nikhitha Mantri, MD⁴, Lucy Joo, DO⁴, C. Jonathan Foster, DO⁵
1Westchester Medical Center, Elmwood Park, NJ; 2Rowan-Virtua School of Osteopathic Medicine, Valhalla, NY; 3Westchester Medical Center, Valhalla, NY; 4Jefferson Health, Cherry Hill, NJ; 5Jefferson Health, Sewell, NJ

Introduction: Esophageal varices are a common and potentially life-threatening condition requiring timely intervention. Endotracheal intubation can be critical in the acute management of these patients in the intensive care unit (ICU) setting, yet the optimal timing of intubation remains unclear. Despite existing clinical guidelines, robust comparative data on early vs. late endotracheal intubations for esophageal varices is lacking. This retrospective study investigates the impact of intubation timing on clinical outcomes in patients with esophageal varices.

Methods: Data were extracted from the National Inpatient Sample database for 2019 and 2020, identifying adult hospitalizations with a primary diagnosis of esophageal varices who underwent intubation. Patients were categorized into early (intubation within 24 hours of admission) and late (intubation after 24 hours) groups. The primary outcome was inpatient mortality, while secondary outcomes included intubation-related complications and total hospital charges. Statistical analyses were conducted using SPSS.

Results: This study included 5,842 patients who had esophageal varices and required intubation of which 2,056 (35.2%) underwent early intubation (within 24 hours) and 3,786 (65.8%) underwent late intubation (after 24 hours). Analysis of the cohort showed that the late intubation group had significantly higher inpatient mortality (26.4% vs. 14.5%, p< 0.001) (OR 2.818, CI 2.670-2.975, p< 0.001). Late intubation percentages were also found to be higher in older age groups, eighties and older, seventies, and sixties (1.8% vs. 1.0%, 6.9% vs. 3.4%, 19.0% vs. 9.1%, respectively). Secondary analysis showed that late intubation was associated with higher complications, including higher rates of anemia (OR 2.690, CI 2.587-2.796, p< 0.001), thrombocytopenia (OR 2.830, CI 2.684-2.984, p< 0.001), coagulopathy (OR 3.122, CI 2.963-3.289, p< 0.001), hypertension (OR 4.149, CI 3.761-4.576, p< 0.001), esophageal ulcer (OR 3.496, CI 2.995-4.079, p< 0.001), shock (OR 2.383, CI 2.268-2.504, p< 0.001), and pressor requirement (OR 3.420, CI 3.117-3.751, p< 0.001).

Discussion: Early intubation within 24 hours was associated with lower inpatient mortality, shorter hospital stays, reduced complications, and lower hospital charges compared to late intubation. These findings underscore the importance of prompt intervention in the management of esophageal varices to optimize clinical outcomes and resource utilization.

Disclosures:
Daniel Basta indicated no relevant financial relationships.
Tony Elias indicated no relevant financial relationships.
Animita Saha indicated no relevant financial relationships.
Nikhitha Mantri indicated no relevant financial relationships.
Lucy Joo indicated no relevant financial relationships.
C. Jonathan Foster indicated no relevant financial relationships.

Daniel Basta, MD¹, Tony Elias, DO², Animita Saha, MD³, Nikhitha Mantri, MD⁴, Lucy Joo, DO⁴, C. Jonathan Foster, DO⁵. P0593 - The Effect of Intubation Timing on Mortality and Complications in Patients With Esophageal Varices, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.