S3165 The Hidden Burden of Non-Diabetic Gastroparesis: A Population-Based Study of Hospitalization Outcomes

Introduction: Gastroparesis is a debilitating gastrointestinal motility disorder often associated with diabetes and its complications, including diabetic polyneuropathy (DPN). While DPN is a recognized risk factor for gastroparesis, limited data exist comparing the clinical profiles, healthcare utilization, and procedural patterns of gastroparesis hospitalizations with versus without coexisting DPN. Methods: We conducted a population-based cohort study using deidentified data from acute care hospitalizations in Texas (Q1 2016-Q2 2024) to examine outcomes in adults with gastroparesis (ICD-10-CM: K 31.84). The primary exposure was diabetic neuropathy identified using ICD-10-CM codes E0843, E0943, E1043, E1143, and E1343. Hospitalizations were included if gastroparesis was the principal diagnosis or listed secondary to diabetic neuropathy. Primary outcomes were length of stay and inflation-adjusted total charges. Overlap propensity score weighting was used, with results reported as adjusted risk ratios and 95% confidence intervals (aRR [95% CI]). Results: Of 33,103 gastroparesis-related hospitalizations, 81.8% had coexisting DPN. Compared to those with DPN, patients without DPN were more often White (55.7% vs 31.7%), women (67.5% vs 58.1%), with higher rates of mental health disorders (45.0% vs 34.2%), malnutrition, and rheumatologic conditions (all P < 0.0001). In contrast, DPN patients were more likely to be middle-aged, and had a higher burden of comorbidities, including heart failure (15.4% vs 6.8%), renal disease (39.0% vs 11.9%), and diabetes-related complications (99.9% vs 3.0%). In the propensity score-matched cohort, non-DPN patients had longer stays (4.96 vs 4.03 days; aRR 1.23) and higher charges ($65,677 vs $56,859; aRR 1.16), with greater use of diagnostic endoscopy, particularly esophagogastroduodenoscopy with biopsy. Despite higher comorbidity in DPN patients, resource use was greater in the non-DPN group. Conclusion: In this large, nationally representative cohort, gastroparesis hospitalizations with DPN were characterized by greater comorbidity burden, whereas those without DPN demonstrated higher diagnostic and procedural intensity, longer hospital stays, and increased costs. These findings suggest a divergence in clinical approach, potentially driven by greater diagnostic uncertainty in non-DPN patients and highlight the need for tailored care pathways based on underlying etiologies.