S949 Trends and Outcomes of Endoscopic vs Surgical Management of Boerhaave Syndrome: A National Inpatient Sample Analysis (2018-2022)

Introduction: Boerhaave syndrome is a rare but life-threatening gastrointestinal emergency. Management strategies typically involve surgical repair or increasingly common endoscopic intervention. Data comparing national trends and inpatient outcomes between these approaches remain limited. Understanding how these strategies differ in terms of mortality, complications, and resource utilization is critical for optimizing patient care. Methods: We used the National Inpatient Sample (2018-2022) to identify adult hospitalizations with a principal diagnosis of Boerhaave syndrome (ICD-10: K22.3). Patients were stratified into endoscopic or surgical management groups using International Classification of Diseases-10-PCS procedure codes. Outcomes included inpatient mortality, length of stay (LOS), and complications (sepsis, mediastinitis, intensive care unit [ICU]-level care). Multivariable survey-weighted logistic and linear regressions were used to compare outcomes between groups and assess trends over time. Results: Among 2,865 hospitalizations, 1,340 (46.8%) underwent endoscopic management, 1,080 (37.7%) surgical, and 445 (15.5%) both. Mortality was highest with endoscopic management (8.6%) compared to surgical (6.9%) and combined approaches (3.4%). Endoscopic management was associated with higher mortality odds (adjusted odds ratio [aOR] 1.61; 95% confidence interval [CI] 1.01-2.59). ICU admissions were significantly more common in surgical and combined groups (P < 0.001). Surgical management showed notably higher sepsis complications (aOR 4.06; 95% CI 2.88-5.71). Mediastinitis was rare across groups. LOS was shortest with endoscopic management (11.2 days vs 18.8-19.0 days). Endoscopic management increased from 44.4% in 2018 to 54.1% in 2022, while surgical interventions declined. Mortality odds did not significantly differ year-to-year. Conclusion: In this large, real-world cohort, endoscopic management of Boerhaave syndrome, though less invasive, was associated with higher inpatient mortality and lower ICU utilization compared to surgical approaches. Surgical and combined interventions demonstrated higher resource use and sepsis rates but lower mortality. These findings show the importance of individualized treatment selection and suggest that while endoscopy may be appropriate in selected patients, outcomes may vary based on clinical severity and timing of intervention. Further studies are warranted to define optimal management strategies better.