Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.744
Peer-review started: September 13, 2022
First decision: October 19, 2022
Revised: November 5, 2022
Accepted: November 28, 2022
Article in press: November 28, 2022
Published online: January 28, 2023
Healthcare resource utilization declined during the coronavirus pandemic. How this impacted gastrointestinal (GI) disease hospitalizations is not fully understood. We sought to investigate trends in hospitalizations, inpatient endoscopy utilization and outcomes during the first year of the pandemic and lockdowns.
The need for a population level understanding of the impact of the coronavirus pandemic on the outcomes of patients hospitalized with GI diseases.
To investigate trends in hospitalizations, inpatient endoscopy utilization and outcomes during the first year of the pandemic and lockdowns.
Using the California State Inpatient Database for 2018-2020, we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality (all-cause & viral pneumonia-specific) for common inpatient GI diagnoses including acute pancreatitis, diverticulitis, cholelithiasis, noninfectious gastroenteritis, upper and lower GI bleeding (LGIB), Clostridium difficile, viral gastroenteritis, inflammatory bowel disease, and acute cholangitis, using regression analyses. We also investigated endoscopy utilization for GI emergencies.
Disease-specific hospitalizations decreased for all included conditions except nonvariceal upper GI bleeding (NVUGIB), LGIB, and ulcerative colitis (UC) (ptrend < 0.0001). All-cause inpatient mortality was higher in 2020 compared to 2019, for acute pancreatitis (P = 0.029), diverticulitis (P = 0.04), NVUGIB (P = 0.003), and Crohn’s disease (P = 0.004). In 2020, hospitalization rates were lowest in April, November, and December. There was no significant corresponding increase in inpatient mortality except in UC (ptrend = 0.048). Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB in which it was lower (P < 0.001).
Our findings suggest that hospitalization rates for common GI conditions significantly declined in California during the COVID pandemic, particularly in April, November and December 2020. All-cause mortality was significantly higher among acute pancreatitis, diverticulitis, NVUGIB, and Crohn’s disease hospitalizations. Emergency endoscopy rates were mostly comparable between 2020 and 2019.
We observed that patients hospitalized with acute pancreatitis, diverticulitis, nonvariceal upper GI bleeding and Crohn’s disease experienced higher all-cause inpatient mortality during the pandemic. Further research is needed to elucidate the disease-specific and system-based risk factors for the increase in mortality observed in these conditions.