Upper-gastrointestinal bleeding secondary to peptic ulcer disease: Incidence and outcomes

doi:10.3748/wjg.v20.i46.17568

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World Journal of Gastroenterology

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World J Gastroenterol. Dec 14, 2014; 20(46): 17568-17577
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17568

Table 1 International Classification of Diseases Codes and Canadian Classification of Health Interventions codes used to define outcomes or procedures

ICD-10 codes used to define perforation with UGIB secondary to PUD
Perforated ulcer	K25.2, K25.6, K26.2, K26.6, K27.2, K27.6, K28.2, K28.6
Non-perforated ulcer	K25.0, K25.4, K26.0, K26.4, K27.0, K27.4, K28.0, K28.4
CCI codes used to define surgery
Stomach repair	1.NF.80.DA, 1.NF.80.DA-XX-E, 1.NF.80.DA-XX-N, 1.NF.80.LA, 1.NF.80.LA-XX-E, 1.NF.80.LA-XX-N
Partial excision of stomach	1.NF.87.BA, 1.NF.87.DA, 1.NF.87.DG, 1.NF.87.DH, 1.NF.87.DJ, 1.NF.87.DL, 1.NF.87.DQ, 1.NF.87.GX, 1.NF.87.LA, 1.NF.87.RG, 1.NF.87.RH, 1.NF.87.RJ, 1.NF.87.RK, 1.NF.87.RP, 1.NF.87.SH
Total excision of stomach	1.NF.89.DZ, 1.NF.89.GW, 1.NF.89.SG, 1.NF.89.TH
Small intestine repair	1.NK.80.DA, 1.NK.80.DA-W2, 1.NK.80.DA-XX-E, 1.NK.80.LA, 1.NK.80.LA-W2, 1.NK.80.LA-XX-E
Partial excision of small intestine	1.NK.87.BA, 1.NK.87.DA, 1.NK.87.DN, 1.NK.87.DP, 1.NK.87.DX, 1.NK.87.DY, 1.NK.87.LA, 1.NK.87.RE, 1.NK.87.RF, 1.NK.87.TF, 1.NK.87.TG
CCI codes used to define interventional radiology
Control of bleeding in stomach using percutaneous transluminal (transarterial) approach	1.NF.13.GP-C2, 1.NF.13.GP-GE, 1.NF.13.GP-WO
Control of bleeding in small and large intestine using percutaneous transluminal (transarterial) approach	1.NP.13.GQ-C2, 1.NP.13.GQ-GE, 1.NP.13.GQ-WO
CCI codes used to define an upper endoscopic procedure
Control of bleeding in stomach	1.NF.13.BA, 1.NF.13.BA-AG, 1.NF.13.BA-BD, 1.NF.13.BA-C2, 1.NF.13.BA-FA, 1.NF.13.BA-GX, 1.NF.13.BA-KK, 1.NF.13.BA-W4, 1.NF.13.BA-X7
Stomach repair	1.NF.80.BA
Inspection or biopsy of stomach	2.NF.70.BA, 2.NF.70.BN, 2.NF.71.BA, 2.NF.71.BP, 2.NF.71.BR
Inspection or biopsy of small intestine	2.NK.70.BA, 2.NK.70.BA-BL, 2.NK.70.BN-BL, 2.NK.71.BA,
Inspection or biopsy of small intestine	2.NK.71.BA-BL, 2.NK.71.BR-BL
Control of bleeding in small and large intestine	1.NP.13.BA-C2, 1.NP.13.BA-KK, 1.NP.13.BA-GX

ICD-10: International Classification of Diseases Codes; CCI: Canadian Classification of Health Interventions; UGIB: Gastrointestinal bleeding; PUD: Peptic ulcer disease.

Table 2 Characteristics of patients admitted to hospital with incidence of gastrointestinal bleeding secondary to peptic ulcer disease n (%)

	All hospitalized patients with UGIB Secondary to PUD	Patients admitted for UGIB Secondary to PUD
	n =7079	n = 4713
Female	2784 (39.3)	1841 (39.1)
Age ≥ 65 yr	4307 (60.8)	2720 (57.7)
Rural	1318 (18.6)	883 (18.7)
Underwent upper endoscopy	5422 (76.6)	3466 (73.5)
Underwent interventional radiology treatment	42 (0.6)	26 (0.6)
Underwent both interventional radiology and surgery¹	10 (23.8)	7 (26.7)
Comorbidities
No comorbidities	3016 (42.6)	2491 (52.9)
1-2 comorbidities	2329 (32.9)	1460 (31.0)
≥ 3 comorbidities	1734 (24.5)	762 (16.2)
In-hospital mortality	601/7079 (8.5)	175/4722 (3.7)
30-d readmission with UGIB secondary to PUD²	301/6478 (4.7)	229/4538 (5.1)
Surgical intervention	305/7079 (4.3)	200/4722 (4.2)

¹Percentage reflects the proportion of patients who underwent surgery among those patients undergoing an interventional radiology intervention;

²Those who died in hospital were excluded from the calculation for readmission. UGIB: Gastrointestinal bleeding; PUD: Peptic ulcer disease.

Table 3 Adjusted odds ratio (95%CI) among all hospitalized patients with an gastrointestinal bleeding secondary to peptic ulcer disease; admitted for any cause (n = 7079)

	In-hospital mortality (95%CI)	30-d readmission (95%CI)¹	Surgical intervention (95%CI)
One year increase (yr)	0.98 (0.94-1.02)	1.07 (1.01-1.14)	0.98 (0.93-1.04)
Female to male	1.28 (1.07-1.53)	1.16 (0.91-1.47)	0.94 (0.74-1.20)
Age ≥ 65 yr to age < 65 yr	1.68 (1.37-2.06)	1.57 (1.21-2.04)	0.74 (0.58-0.94)
Rural to urban	0.90 (0.71-1.14)	2.30 (1.79-2.95)	0.90 (0.66-1.22)
Perforation to no perforation	3.14 (2.03-4.85)	1.59 (0.76-3.33)	Not applicable
Surgery²	2.23 (1.56-3.20)	1.16 (0.62-2.15)	Not applicable
Interventional radiology²	2.41 (1.07-5.41)	0.70 (0.09-5.16)	7.18 (3.48-14.84)
Upper endoscopy²	1.08 (0.86-1.35)	0.58 (0.45-0.74)	0.86 (0.66-1.13)
Charlson comorbidities³
1-2 comorbidities	3.13 (2.36-4.16)	1.14 (0.86-1.49)	1.07 (0.81-1.41)
≥ 3 comorbidities	9.51 (7.28-12.43)	1.20 (0.88-1.64)	1.04 (0.77-1.41)

¹Those who died in hospital were excluded from the calculation for readmission;

²Those who had the procedure performed compared to those who did not;

³Patients who had no comorbidities was used as the reference group. UGIB: Gastrointestinal bleeding; PUD: Peptic ulcer disease.

Table 4 Adjusted odds ratio (95%CI) among all hospitalized patients with Gastrointestinal bleeding due to gastric or duodenal ulcers (n = 6356)

	In-hospital mortality (95%CI)	30-d readmission (95%CI)¹	Surgical intervention (95%CI)
Duodenal vs gastric ulcer	1.27 (1.05-1.53)	1.54 (1.19-1.99)	1.73 (1.34-2.23)
One year increase (yr)	0.98 (0.93-1.02)	1.08 (1.02-1.15)	0.99 (0.93-1.05)
Female to male	1.22 (1.01-1.48)	1.26 (0.97-1.63)	0.96 (0.74-1.24)
Age ≥ 65 yr to age < 65 yr	1.65 (1.33-2.05)	1.59 (1.20-2.10)	0.76 (0.59-0.98)
Rural to urban	0.83 (0.64-1.08)	2.36 (1.80-3.09)	1.00 (0.73-1.38)
Perforation to no perforation	2.32 (1.44-3.75)	1.29 (0.58-2.84)	Not Applicable
Surgery²	2.52 (1.73-3.68)	1.29 (0.69-2.43)	Not Applicable
Interventional radiology²	2.22 (0.99-4.99)	0.59 (0.08-4.41)	5.74 (2.69-12.27)
Upper endoscopy²	1.24 (0.96-1.59)	0.59 (0.45-0.77)	0.77 (0.58-1.01)
Charlson comorbidities³
1-2 comorbidities	3.19 (2.35-4.32)	1.29 (0.96-1.73)	1.06 (0.79-1.41)
≥ 3 comorbidities	9.87 (7.42-13.14)	1.33 (0.96-1.85)	1.00 (0.73-1.37)

¹Those who died in hospital were excluded from the calculation for readmission (n = 5813 included in the analysis);

²Those who had the procedure performed compared to those who did not;

³Patients who had no comorbidities was used as the reference group. Patients with ulcers in both the stomach and duodenum or unspecified locations were excluded in this sensitivity analysis.

Table 5 Adjusted odds ratio (95%CI) among all hospitalized patients where gastrointestinal bleeding secondary to peptic ulcer disease was the primary reason for hospital stay (n = 4713)

	In-hospital mortality (95%CI)	30-d readmission (95%CI)¹	Surgical intervention (95%CI)
One year increase (yr)	0.96 (0.89-1.04)	1.09 (1.02-1.16)	0.99 (0.93-1.07)
Female to male	1.42 (1.03-1.96)	1.02 (0.78-1.35)	1.03 (0.76-1.38)
Age ≥ 65 yr to age < 65 yr	2.90 (1.90-4.43)	1.83 (1.35-2.47)	0.78 (0.58-1.06)
Rural to urban	0.89 (0.59-1.35)	2.35 (1.77-3.14)	1.10 (0.77-1.57)
Perforation to no perforation	3.70 (2.05-6.69)	1.35 (0.60-3.04)
Surgery²	3.30 (1.89-5.74)	1.42 (0.72-2.8)
Interventional radiology²	4.89 (1.54-15.54)	0.88 (0.11-6.7)	8.59 (3.54-20.85)
Upper endoscopy²	0.62 (0.44-0.88)	0.71 (0.53-0.95)	0.79 (0.58-1.08)
Charlson comorbidities³
1-2 comorbidities	2.56 (1.67-3.95)	1.22 (0.90-1.66)	1.30 (0.94-1.81)
≥ 3 comorbidities	6.63 (4.33-10.16)	1.33 (0.92-1.94)	1.24 (0.83-1.87)

¹Those who died in hospital were excluded from the calculation for readmission (n = 4538);

²Those who had the procedure performed compared to those who did not;

³Patients who had no Charlson comorbidities was used as the reference group.

Table 6 Adjusted odds ratio (95%CI) among all hospitalized patients with an gastrointestinal bleeding secondary to peptic ulcer disease and a Canadian Classification of Health Interventions procedural code for an upper endoscopy (n = 5422)

	In-hospital mortality	30-d readmission¹	Surgical intervention
One year increase (yr)	0.98 (0.94-1.03)	1.10 (1.02-1.18)	0.98 (0.91-1.05)
Female to male	1.35 (1.10-1.64)	1.13 (0.84-1.51)	0.92 (0.69-1.22)
Age ≥ 65 yr to age < 65 yr	1.56 (1.24-1.95)	1.70 (1.23-2.36)	0.64 (0.49-0.85)
Rural to urban	0.90 (0.69-1.17)	2.51 (1.85-3.41)	0.88 (0.61-1.27)
Perforation to no perforation	1.96 (1.08-3.57)	1.65 (0.65-4.16)	Not Applicable
Surgery²	2.04 (1.34-3.1)	1.64 (0.85-3.18)	Not Applicable
Interventional radiology²	2.30 (0.95-5.55)	0.74 (0.10-5.52)	5.38 (2.32-12.47)
Charlson comorbidities³
1-2 comorbidities	3.21 (2.3-4.47)	1.28 (0.92-1.79)	1.03 (0.75-1.41)
≥ 3 comorbidities	10.32 (7.55-14.1)	1.12 (0.76-1.64)	1.01 (0.72-1.43)

¹Those who died in hospital were excluded from the calculation for readmission (n = 4940 included in analysis);

²Those who had the procedure performed compared to those who did not;

³Patients who had no Charlson comorbidities was used as the reference group.

Citation: Quan S, Frolkis A, Milne K, Molodecky N, Yang H, Dixon E, Ball CG, Myers RP, Ghosh S, Hilsden R, van Zanten SV, Kaplan GG. Upper-gastrointestinal bleeding secondary to peptic ulcer disease: Incidence and outcomes. World J Gastroenterol 2014; 20(46): 17568-17577
URL: https://www.wjgnet.com/1007-9327/full/v20/i46/17568.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i46.17568