Trends in toxicity-associated hospitalizations and inpatient outcomes among gastrointestinal malignancies in the United States, 2016–2023.

Abstract

e23237 Background: Advances in systemic therapy for gastrointestinal (GI) malignancies have expanded rapidly, including immune checkpoint inhibitors, targeted agents, and combination regimens. While outpatient survival has improved, it remains unclear whether inpatient outcomes during cancer-related hospitalizations have improved in parallel. We evaluated national trends in toxicity-associated hospitalizations and inpatient outcomes among GI malignancies across contemporary treatment eras. Methods: A retrospective, survey-weighted analysis of the National Inpatient Sample (2016–2023) was conducted. Adult hospitalizations with any gastrointestinal malignancy (ICD-10-CM C15–C20, C22–C25) were included, excluding encounters with palliative care coding (Z51.5). Treatment era was defined as 2016–2017 versus 2018–2023. Toxicity-like syndromes were identified using diagnosis proxies, including neutropenic sepsis (D70 with A40/A41), acute kidney injury (N17), colitis or severe diarrhea (K52, A09), respiratory failure or pneumonitis (J96, J80), myocarditis or shock (I40, R57), and electrolyte disorders (E87). Outcomes included in-hospital mortality, ICU escalation proxies (mechanical ventilation or shock), length of stay, hospitalization cost, and rescue outcomes defined as mortality among ICU, sepsis, and AKI hospitalizations. Results: The cohort included 748,734 weighted hospitalizations. The prevalence of toxicity-associated syndromes increased from 42.4% in 2016 to 53.4% in 2023. ICU escalation increased modestly from 4.0% to 4.3%, while inpatient mortality declined from 3.21% (95% CI, 3.06–3.37) to 2.53% (95% CI, 2.39–2.67). Compared with the transition era, the modern era demonstrated higher toxicity-associated hospitalizations (50.1% [95% CI, 49.8–50.4] vs 43.3% [95% CI, 42.9–43.8]) with minimal mortality difference (2.91% [95% CI, 2.85–2.97] vs 3.12% [95% CI, 3.02–3.23]). Mean LOS increased from 6.01 to 6.36 days, and mean cost increased from $21,318 to $24,547. Among toxicity-associated hospitalizations, mortality declined modestly from 6.16% (95% CI, 5.96–6.38) to 5.23% (95% CI, 5.12–5.33). Mortality among ICU hospitalizations remained high across eras (30.8% [95% CI, 29.7–32.0] vs 29.9% [95% CI, 29.3–30.6]). Conclusions: Among U.S. hospitalizations involving GI malignancies, toxicity-associated organ dysfunction and ICU escalation increased substantially in the modern treatment era, while inpatient mortality improved only modestly and remained high following critical illness. These findings highlight a growing inpatient care burden accompanying contemporary GI oncology treatment and underscore the need to align therapeutic advances with improved inpatient rescue capacity.