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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2023; 15(4): 285-296
Published online Apr 16, 2023. doi: 10.4253/wjge.v15.i4.285
Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding: A nationwide analysis
Simcha Weissman, Muhammad Aziz, Ayrton I Bangolo, Dean Ehrlich, Arnold Forlemu, Anthony Willie, Manesh K Gangwani, Danish Waqar, Hannah Terefe, Amritpal Singh, Diego MC Gonzalez, Jayadev Sajja, Fatma L Emiroglu, Nicholas Dinko, Ahmed Mohamed, Mark A Fallorina, David Kosoy, Ankita Shenoy, Anvit Nanavati, Joseph D Feuerstein, James H Tabibian
Simcha Weissman, Ayrton I Bangolo, Anthony Willie, Danish Waqar, Hannah Terefe, Amritpal Singh, Diego MC Gonzalez, Jayadev Sajja, Fatma L Emiroglu, Nicholas Dinko, Ahmed Mohamed, Mark A Fallorina, David Kosoy, Ankita Shenoy, Anvit Nanavati, Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
Muhammad Aziz, Manesh K Gangwani, Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH 43614, United States
Dean Ehrlich, Division of Digestive Diseases, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States
Arnold Forlemu, Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85012, United States
Joseph D Feuerstein, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
James H Tabibian, Division of Gastroenterology, Department of Medicine, Olive View- University of California at Los Angeles Medical Center, Sylmar, CA 91342, United States
Author contributions: Weissman S, Aziz M, and Bangolo A searched the literature, wrote, and revised the manuscript; Ehrlich D, Forlemu A, Willie A, Gangwani MK, Waqar D, Terefe H, Singh A, Gonzalez DMC, Sajja J, Emiroglu FL, Dinko N, Mohamed A, Fallorina MA, Kosoy D, Shenoy A, and Nanavati A revised and edited the manuscript; Feuerstein JD and Tabibian JH approved the final version and are the article’s guarantors; All authors certify that they contributed sufficiently to the intellectual content and data analysis; Each author has reviewed the final version of the manuscript and approved it for publication.
Conflict-of-interest statement: All the authors have no potential conflict of interest to disclose.
Data sharing statement: The National Inpatient Sample is a publicly available dataset.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ayrton I Bangolo, MBBS, MD, Doctor, Department of Internal Medicine, Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, United States. ayrtonbangolo@yahoo.com
Received: December 16, 2022
Peer-review started: December 16, 2022
First decision: February 20, 2023
Revised: February 22, 2023
Accepted: March 15, 2023
Article in press: March 15, 2023
Published online: April 16, 2023
Processing time: 119 Days and 1.8 Hours
ARTICLE HIGHLIGHTS
Research background
Patients are often admitted for nonvariceal upper Gastrointestinal bleeding (NVUGIB). However, there is not enough data on the importance and timing of esophagogastroduodenoscopy (EGD) in those scenarios.
Research motivation
The main motivation of this study was to identify independent predictors of outcomes in patients with NVUGIB, with a particular focus on EGD timing, anticoagulation (AC) status, and demographic features.
Research objectives
The purpose of this study was to analyze a large, nationwide database to identify risk factors that predict differences in outcomes in patients hospitalized for NVUGIB—with a particular focus on timing to EGD, anticoagulation status, and demographic features.
Research methods
This was a retrospective analysis of patients with NVUGIB from 2009 to 2014, using validated ICD-9 codes from the National Inpatient Sample database. Patients were stratified by EGD timing relative to hospital admission (≤ 24 h, 24-48 h, 48-72 h, and > 72 h) and then by AC status (yes/no). The primary outcome was all-cause inpatient mortality. Secondary outcomes included healthcare usage.
Research results
553186 (51.1%) patients underwent EGD between 2009-2014. The mean time to EGD was 52.8 h. Early (< 24 h from admission) EGD was associated with significantly decreased mortality, less frequent ICU admission, shorter length of hospital stays, lower hospital costs, and an increased likelihood of discharge to home (all with P < 0.001). AC status was not associated with mortality among patients who underwent early EGD (aOR 0.88, P = 0.193). Male sex (OR 1.30) and Hispanic (OR 1.10) or Asian (aOR 1.38) race were also independent predictors of adverse hospitalization outcomes in NVUGIB.
Research conclusions
Early EGD (within 24 h) is associated with lower mortality, less hospital cost and less healthcare utilization; regardless of the consumption of anticoagulants.
Research perspectives
Randomized clinical trials examining the timing of EGD in NVUGIB will be difficult to conduct. Thus, the data of our study can shed some light on this clinically important subject. Additionally, we identified numerous other factors such as-Male sex, Hispanic or Asian race, Medicaid insurance, age > 50, and those with more numerous comorbidities, all of which may help predict patients at high risk for adverse hospital outcomes in NVUGIB.
