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Objectives: Median Arcuate Ligament Syndrome (MALS) results from celiac artery compression by the median arcuate ligament and is most often associated with chronic abdominal pain. The objective of this study was to evaluate the outcomes of MALS after celiac artery decompression (CAD).
Methods: A retrospective analysis was completed using the Nationwide Inpatient Sample based on ICD-9-CM codes for MALS (447.4) and CAD (39.91) for patient admissions between 1999 and 2011 in the US. Demographic covariates included age and gender. Clinical covariates included Diagnosis-Related Group (DRG) severity of illness scores, mortality scores, comorbidities, and hospital covariates. Outcomes included inpatient mortality, median length of stay (LOS) in days, and adjusted median hospital costs. Data analysis was completed using the IBM SPSS software package (SPSS version 22.0, SPSS Inc., Chicago, IL, USA).
Results: We identified 33,951 patients who were diagnosed with MALS and 1029 patients who underwent CAD. Demographics, comorbidities, hospital covariates, and outcomes are shown in Table 1. Although the results indicate increased mortality in patients who do not undergo surgery (MALS 2.6% vs. CAD 0%; p<0.001), this is more likely due to higher DRG severity of illness (MALS 2.7; CAD 1.7; p<0.001) and risk of mortality (MALS 2.3; CAD 1.2; p<0.001). The incidence of MALS has increased steadily since the year 2000, yet only 2.44% of patients, on average, identified with MALS undergo CAD.
Conclusions: The outcomes of CAD for MALS are excellent. While the incidence of MALS has increased, very few patients undergo CAD. This may represent an opportunity to educate physicians regarding the diagnosis and treatment of MALS.
Table. Demographics, comorbidities, hospital covariates, and outcomes in patients with MALS and in those who undergo CAD.

Variable	MALS	CAD	Significance
Demographics
Age	67.9 +/- 15.7	40.9 +/- 17.4	P<0.001
Female	66.9%	73.9%	P<0.001
Number of chronic conditions	7.3 +/- 3.1	3.5 +/- 2.3	P<0.001
Number of diagnoses on record	11.3 +/- 5.3	6.3 +/- 4.6	P<0.001
DRG severity of illness	2.7 +/- 0.7	1.7 +/- 0.8	P<0.001
DRG risk of mortality	2.3 +/- 0.9	1.2 +/- 0.5	P<0.001
Comorbidities
Iron deficiency anemia	19.8%	4.7%	P<0.001
Congestive heart failure	11.2%	0.0%	P<0.001
COPD	25.1%	12.2%	P<0.001
Depression	12.8%	9.3%	P<0.01
Diabetes	17.1%	3.1%	P<0.001
Hypertension	61.1%	22.4%	P<0.001
Fluid and electrolyte disorders	28.1%	9.5%	P<0.001
Peripheral vascular disorder	49.5%	14.3%	P<0.001
Renal failure	15.5%	0.8%	P<0.001
Weight loss	12.4%	10.0%	N.S.
Hospital Covariates
Urban hospital location	92.2%	97.3%	P<0.001
Teaching hospital	51.5%	82.2%	P<0.001
Outcomes
Length of stay (days)	5 (3-8)	4 (3-7)	N.S.
Total costs (2014 USD)	$13,129 (7,716-22,628)	$16,107 (11,466-23,610)	P<0.01
Inpatient mortality	2.6%	0.0%	P<0.001