GI Bleeding

26 - Trends of Early Colonoscopy and Their Outcomes in Patients Admitted With Acute Lower Gastrointestinal Bleeding

Tuesday, October 9
9:40 AM - 9:50 AM
Location: Terrace Ballroom 4 (level 400)

Category: GI Bleeding
Kalpit Devani, MD1, Paris Charilaou, MD2, Dhruvil Radadiya, MBBS1, Hardik Sonani, MBBS3, Chakradhar M. Reddy, MD, FACP4, Mark Young, MD1, Bhaumik Brahmbhatt, MBBS5
1East Tennessee State University, Johnson City, TN; 2St. Peter's University Hospital, New Brunswick, NJ; 3University of Mississippi, Jackson, AL; 4East Tennessee State University, Quillen College of Medicine, Johnson City, TN; 5Mayo Clinic, Jacksonville, FL

Award: Fellows-in-Training Award (GI Bleeding Category)

Introduction: Current guidelines suggest performing an early colonoscopy for patients admitted with acute lower gastrointestinal bleeding (LGIB). It is not clear whether this practice is implemented widely or it improves inpatient outcomes. Therefore, we investigated trends of early colonoscopy and their outcomes in patients admitted with LGIB.

Methods: Nationwide Inpatient Sample (NIS) was utilized to identify adult patients with LGIB admitted from 2005 to 2014. We excluded cases with missing data on age, gender & inpatient mortality. ICD-9-CM codes were used to extract LGIB discharges as a primary diagnosis or with LGIB as a secondary diagnosis with a concomitant primary diagnosis of unspecified LGIB. "Early colonoscopy" (EC) was defined as colonoscopy done within 24 hours of admission. Hospitalization Costs (HC) were inflation-adjusted. The effect of early colonoscopy, as well as other predictors of patient mortality, HC, and LOS,  were assessed by multivariable mixed-models logistic, linear regression, and accelerated-failure time models, respectively. NIS weights yielded national estimates.

Results: Total of 1,526,829 patients with LGIB were included, 53.3% were females and 70% white. Most common etiology was diverticular bleeding (47.6%). 37% of patient underwent EC, 24% had a late colonoscopy (LC), while 38% had no colonoscopy (NC). Baseline characteristics of the patient population are shown in Table 1. Over the study period, there was an increasing trend of utilization of EC while patients undergoing LC and NC decreased. Trends in the outcomes in each group are shown in fig 1. Independent predictors of mortality are age, surgery requirement, ICU admission, acute kidney injury (AKI), blood transfusion. There was statistically no significant mortality difference between patients undergoing EC vs. LC, but NC was associated with significantly higher mortality compared to LC. However, EC was associated with 32% lower in LOS and 9% lower hospitalization cost compared to LC. Sensitivity analysis was performed amongst a subset of patients who underwent a colonoscopy, and it showed similar findings mortality (OR: 0.91, p=0.16). Predictors of LOS, HC, and mortality amongst patients with LGIB are shown in Table 2.

Discussion: Utilization of early colonoscopy in the management of LGIB is rising steadily. It is associated with significantly lower LOS and cost of hospitalization. However, inpatient mortality is unaffected. ICU admission, AKI and surgery requirement are strongest predictors of mortality.

Table 1: Baseline characteristics of patients
Table 2: Predictors of length of stay, cost of hospitalization and mortality
Figure 1: Trends of utilization and timing of colonoscopy and their outcomes

Disclosures:
Kalpit Devani indicated no relevant financial relationships.
Paris Charilaou indicated no relevant financial relationships.
Dhruvil Radadiya indicated no relevant financial relationships.
Hardik Sonani indicated no relevant financial relationships.
Chakradhar Reddy indicated no relevant financial relationships.
Mark Young indicated no relevant financial relationships.
Bhaumik Brahmbhatt indicated no relevant financial relationships.

Kalpit Devani

Resident Physician
East Tennessee State University
Johnson City, Tennessee

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