Early Colonoscopy in Hospitalized Patients With Acute Lower Gastrointestinal Bleeding: A Nationwide Analysis.

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY
Gastroenterology Research Pub Date : 2022-08-01 Epub Date: 2022-08-23 DOI:10.14740/gr1536
Kuldeepsinh P Atodaria, Samyak Dhruv, Joseph M Bruno, Brisha Bhikadiya, Shravya R Ginnaram, Shreeja Shah
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引用次数: 0

Abstract

Background: Performing colonoscopy within 24 h of presentation to the hospital is the accepted standard of care for patients with an acute lower gastrointestinal bleed (LGIB). Previous studies have failed to demonstrate the benefit of early colonoscopy (EC) on mortality. In this study, we wanted to see if there was a change in inpatient deaths (primary outcome), length of stay (LOS), and hospitalization charges (TOTCHG) (secondary outcomes) with EC compared to previous studies.

Methods: Adults diagnosed with LGIB were identified using the International Classification of Disease 10th Revision codes from the National Inpatient Sample database for 2016 to 2019. EC was defined as the procedure performed within 24 h of hospitalization. Delayed colonoscopy (DC) was defined as a procedure performed after 24 h of presentation. The patient population was divided into EC and DC groups, and the effects of several covariates on outcomes were measured using binary logistic and multivariate regression analysis. Inverse probability treatment weighting (IPTW) was performed to adjust for confounding covariates.

Results: There were 1,549,065 cases diagnosed with LGIB, of which 285,165 cases (18.4%) received a colonoscopy. A total of 107,045 (6.9%) patients received early colonoscopies. EC was associated with decreased inpatient deaths (0.9% in EC, and 1.4% in DC, P < 0.001). However, upon IPTW, this difference was not present. EC was associated with a decreased LOS (median 3 days vs. 5 days, P < 0.001) and TOTCHG (median $32,037 vs. $44,092, P < 0.001). Weekend admissions (WA) were associated with fewer EC (31.6% in WA, and 39.5% in non-WA, P < 0.001). WA did not affect inpatient deaths.

Conclusions: EC was not associated with decreased inpatient deaths. There was no difference in endoscopic interventions in both EC and DC groups. The difference in inpatient deaths observed between the two groups was not evident upon adjusting the results for confounders. EC was associated with a decreased LOS, and TOTCHG in patients with LGIB.

Abstract Image

急性下消化道出血住院患者的早期结肠镜检查:一项全国性分析。
背景:在入院24小时内进行结肠镜检查是急性下消化道出血(LGIB)患者公认的护理标准。先前的研究未能证明早期结肠镜检查(EC)对死亡率的好处。在这项研究中,我们想看看与以前的研究相比,EC在住院患者死亡(主要结局)、住院时间(LOS)和住院费用(次要结局)方面是否有变化。方法:使用2016 - 2019年国家住院患者样本数据库中的国际疾病分类第10次修订代码对诊断为LGIB的成年人进行鉴定。EC定义为住院后24小时内进行的手术。延迟结肠镜检查(DC)被定义为24小时后进行的手术。将患者人群分为EC组和DC组,采用二元logistic和多元回归分析测量多个协变量对结果的影响。采用逆概率处理加权(IPTW)来调整混杂协变量。结果:诊断为LGIB的1549065例,其中285165例(18.4%)接受了结肠镜检查。107,045例(6.9%)患者接受了早期结肠镜检查。EC与住院死亡率降低相关(EC为0.9%,DC为1.4%,P < 0.001)。然而,在IPTW时,这种差异不存在。EC与LOS(中位3天vs. 5天,P < 0.001)和TOTCHG(中位32,037美元vs. 44,092美元,P < 0.001)降低相关。周末入院(WA)与较少的EC相关(WA为31.6%,非WA为39.5%,P < 0.001)。睡眠不足对住院病人死亡没有影响。结论:EC与住院死亡率的降低无关。内镜干预在EC组和DC组中没有差异。在调整混杂因素的结果后,两组之间观察到的住院患者死亡的差异并不明显。EC与LGIB患者的LOS和TOTCHG降低有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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