S826 The Effect of Intubation Timing on Mortality and Complications in Patients With Esophageal Varices

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 Statistical Package for the Social Sciences. 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) (odds ratio [OR] 2.818; confidence interval [CI] 2.670-2.975, P < 0.001). Late intubation percentages were also found to be higher in older age groups, 80s and older, 70s, and 60s (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). Conclusion: 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.