Philip Twene, MD, MPH1, Richard Ogunti, MD1, Joseph Asemota, MD, MPH1, Diena Abdelmaged, MD1, Chandana Lanka, MD2, Daniel A. Larbi, MD1, Adeyinka Laiyemo, MD, MPH1; 1Howard University Hospital, Washington, DC; 2Howard University College of Medicine, Washington, DC
Introduction: Management of bleeding peptic ulcer disease (PUD) after failed esophagogastroduodenoscopy (EGD) is challenging. Subsequent interventions include transcatheter arterial embolization (TAE) and urgent surgery. However, comparative effectiveness of these treatment modalities has not been well studied. In this study, we compared the in-hospital outcomes of TAE versus surgical control of PUD after failed endoscopy in the USA over a 10-year period. Methods: We used data from the National Inpatient Sample (NIS) database from 2005 through 2014. We queried the NIS database using the ICD‐9‐CM procedure code of 44.44 for TAE and 44.40, 44.41,44.42 for surgical control of bleeding PUD. Patients that had both TAE and Surgical control of bleeding PUD performed during the same hospital encounter were excluded from the analysis. All patients included in this analysis had failed EGD. We compared the complications associated with the procedures, median length of hospital stay (LOS), and in-hospital mortality using Wilcoxon‐rank sum test for continuous variables and Chi‐square test for categorical variables. Sensitivity analysis was performed using multiple regression analysis. All statistical tests were two‐sided, and results with P < 0.05 were deemed significant. Results: Before Propensity Score Matching 4,574 patients in the TAE group were compared with 28,267 patients in the surgical group. Patients in the TAE group were older (65.4 ± 15.4 vs. 61.7 ± 17.7; p< 0.001), male predominant (48.1% vs. 39.1%, p< 0.001), and had higher predicted one-year mortality based on Charlson Co-morbidity Index Score >/=3 (63.2% vs. 31.1%; p< 0.001). After 1:2 Propensity Score Matching of 27 covariates, 4,574 patients in the TAE group and 9,148 patients in the surgical group were included in the subsequent analysis. TAE was associated with lower risk of acute kidney injury (AKI) (26.4% vs. 31.4%, adjusted-OR 0.70; 95% CI, 0.64 to 0.76), and those who had TAE were less likely to receive hemodialysis for AKI (3.34% vs. 4.39%, adjusted-OR 0.62; 95% CI, 0.51 to 0.75). TAE was associated with shorter median LOS (8 days vs. 10 days, adjusted-OR -3.10; 95% CI, -3.64 to -2.59), and lower in-hospital mortality (12.1% vs. 16.9%, adjusted-OR 0.60; 95% CI, 0.53 to 0.66). Discussion: Our study showed that among patients with refractory bleeding peptic ulcer disease, TAE was associated with better clinical outcomes than emergency surgery. There is a need to increase capacity for interventional radiology interventions in our hospitals.
Table 1: Comparison of the main outcomes between emergency surgery and transcatheter arterial embolization for control of bleeding PUD after failed EGD
Disclosures: Philip Twene indicated no relevant financial relationships. Richard Ogunti indicated no relevant financial relationships. Joseph Asemota indicated no relevant financial relationships. Diena Abdelmaged indicated no relevant financial relationships. Chandana Lanka indicated no relevant financial relationships. Daniel Larbi indicated no relevant financial relationships. Adeyinka Laiyemo indicated no relevant financial relationships.