Higher Area Deprivation Index scores predict incomplete pre-operative high-resolution manometry in Achalasia patients undergoing peroral endoscopic myotomy.

BACKGROUND

The Area Deprivation Index (ADI) is an important measure of neighborhood-level socioeconomic status (SES). Our study evaluates the correlation of ADI scores to post-operative clinic follow up compliance and completion of pre-operative high-resolution manometry (HRM) in patients with Achalasia undergoing Peroral Endoscopic Myotomy (POEM).

METHODS

We conducted a retrospective cohort study of adult patients undergoing POEM at a single tertiary care center between March 2017 and December 2024 (N = 193). ADI was assigned using 2023 national rankings based on patient residential addresses. Analyses were restricted to patients with available ADI data (n = 181). Multivariable logistic regression was performed adjusting for age, travel distance, sex, body mass index (BMI), and smoking status.

RESULTS

Patients who did not complete pre-operative HRM had higher ADI scores (89 [IQR 21]) compared to those who did (85 [IQR 29]), (p = 0.015). Patients who did not attend initial or overall post-operative follow-up also had higher ADI scores compared to those who completed follow-up. Median ADI was higher among patients with incomplete initial follow-up (90 [IQR 17] vs 85 [IQR 28]; p = 0.068) and overall follow-up (91 [IQR 18] vs 85 [IQR 27]; p = 0.064); however, these differences did not reach statistical significance on non-parametric testing. Mean values demonstrated similar patterns but were statistically significant on parametric analysis (p = 0.010 and p = 0.013, respectively). In multivariable logistic regression analysis, higher ADI rank was independently associated with increased odds of failing to complete pre-operative HRM (OR 1.04, 95% CI 1.01-1.07, p = 0.005). Age, travel distance, sex, BMI, and smoking status were not significantly associated with HRM completion (all p > 0.05).

CONCLUSION

Patients with higher ADI scores were less likely to complete HRM pre-operative testing. ADI scores can be used as a measure to risk stratify Achalasia patients undergoing POEM.