Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding

Background and study aims Current guidelines conditionally recommend performing early colonoscopy (EC) (< 24 hours) in patients admitted with acute lower gastrointestinal bleeding (LGIB). It remains unclear whether this practice is implemented widely. Therefore, we used the Nationwide Inpatient S...

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Main Authors: Kalpit Devani, Dhruvil Radadiya, Paris Charilaou, Tyler Aasen, Chakradhar M. Reddy, Mark Young, Bhaumik Brahmbhatt, Don C. Rockey
Format: Article
Language:English
Published: Georg Thieme Verlag KG 2021-05-01
Series:Endoscopy International Open
Online Access:http://www.thieme-connect.de/DOI/DOI?10.1055/a-1352-3204
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spelling doaj-8e46dc674c6e492d913e8f86bc62fbd72021-05-27T22:43:59ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362021-05-010906E777E78910.1055/a-1352-3204Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleedingKalpit Devani0Dhruvil Radadiya1Paris Charilaou2Tyler Aasen3Chakradhar M. Reddy4Mark Young5Bhaumik Brahmbhatt6Don C. Rockey7Division of Gastroenterology and Liver Disease, Department of Internal Medicine, Prisma Health, University of South Carolina, Greenville, South Carolina, United StatesDepartment of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, United StatesDivision of Gastroenterology & Hepatology, Department of Internal Medicine, Saint Peterʼs University Hospital/Rutgers – Robert Wood Johnson Medical School, New Brunswick, New Jersey, United StatesDivision of Gastroenterology & Hepatology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, United StatesDivision of Gastroenterology & Hepatology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, United StatesDivision of Gastroenterology & Hepatology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, United StatesDivision of Gastroenterology & Hepatology, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United StatesDivision of Gastroenterology, Department of Internal Medicine, Medical University of South Carolina, United StatesBackground and study aims Current guidelines conditionally recommend performing early colonoscopy (EC) (< 24 hours) in patients admitted with acute lower gastrointestinal bleeding (LGIB). It remains unclear whether this practice is implemented widely. Therefore, we used the Nationwide Inpatient Sample to investigate trends for timing of colonoscopy in patients admitted with acute LGIB. We also assessed trend of hospitalization and mortality in patients with LGIB. Patients and methods Adult patients with LGIB admitted from 2005 to 2014 were examined. ICD-9-CM codes were used to extract LGIB discharges. Trends were assessed using Cochrane-Armitage test. Factors associated with mortality, cost of hospitalization, and length of stay (LOS) were assessed by multivariable mixed-effects and exact-matched logistic, linear regression, and accelerated-failure time models, respectively. Results A total of 814,647 patients with LGIB were included. The most common etiology of LGIB was diverticular bleeding (49 %) and 45 % of patients underwent EC. Over the study period, there was no change in the trend of colonoscopy timing. Although admission with LGIB increased over the study period, the mortality rate decreased for patients undergoing colonoscopy. Independent predictors of mortality were age, surgery (colostomy/colectomy) during admission, intensive care unit admission, acute kidney injury, and blood transfusion requirement. Timing of colonoscopy was not associated with mortality benefit. However, cost of hospitalization was $ 1,946 lower and LOS was 1.6 days shorter with EC. Conclusion Trends in colonoscopy timing in management of LGIB have not changed over the years. EC is associated with lower LOS and cost of hospitalization but it does not appear to improve inpatient mortality.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1352-3204
collection DOAJ
language English
format Article
sources DOAJ
author Kalpit Devani
Dhruvil Radadiya
Paris Charilaou
Tyler Aasen
Chakradhar M. Reddy
Mark Young
Bhaumik Brahmbhatt
Don C. Rockey
spellingShingle Kalpit Devani
Dhruvil Radadiya
Paris Charilaou
Tyler Aasen
Chakradhar M. Reddy
Mark Young
Bhaumik Brahmbhatt
Don C. Rockey
Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding
Endoscopy International Open
author_facet Kalpit Devani
Dhruvil Radadiya
Paris Charilaou
Tyler Aasen
Chakradhar M. Reddy
Mark Young
Bhaumik Brahmbhatt
Don C. Rockey
author_sort Kalpit Devani
title Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding
title_short Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding
title_full Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding
title_fullStr Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding
title_full_unstemmed Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding
title_sort trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding
publisher Georg Thieme Verlag KG
series Endoscopy International Open
issn 2364-3722
2196-9736
publishDate 2021-05-01
description Background and study aims Current guidelines conditionally recommend performing early colonoscopy (EC) (< 24 hours) in patients admitted with acute lower gastrointestinal bleeding (LGIB). It remains unclear whether this practice is implemented widely. Therefore, we used the Nationwide Inpatient Sample to investigate trends for timing of colonoscopy in patients admitted with acute LGIB. We also assessed trend of hospitalization and mortality in patients with LGIB. Patients and methods Adult patients with LGIB admitted from 2005 to 2014 were examined. ICD-9-CM codes were used to extract LGIB discharges. Trends were assessed using Cochrane-Armitage test. Factors associated with mortality, cost of hospitalization, and length of stay (LOS) were assessed by multivariable mixed-effects and exact-matched logistic, linear regression, and accelerated-failure time models, respectively. Results A total of 814,647 patients with LGIB were included. The most common etiology of LGIB was diverticular bleeding (49 %) and 45 % of patients underwent EC. Over the study period, there was no change in the trend of colonoscopy timing. Although admission with LGIB increased over the study period, the mortality rate decreased for patients undergoing colonoscopy. Independent predictors of mortality were age, surgery (colostomy/colectomy) during admission, intensive care unit admission, acute kidney injury, and blood transfusion requirement. Timing of colonoscopy was not associated with mortality benefit. However, cost of hospitalization was $ 1,946 lower and LOS was 1.6 days shorter with EC. Conclusion Trends in colonoscopy timing in management of LGIB have not changed over the years. EC is associated with lower LOS and cost of hospitalization but it does not appear to improve inpatient mortality.
url http://www.thieme-connect.de/DOI/DOI?10.1055/a-1352-3204
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