A Presidential Poster Award winning abstract revealed that while the rate of inpatient colonoscopy has increased over the past decade and patients presenting with lower gastrointestinal bleeding (LGIB) tend to be sicker, the inpatient mortality rate has been dropping among patients admitted.

The presentation was made by Rabia Rizwan, MD, from Yale University School of Medicine in New Haven, Connecticut, at the American College of Gastroenterology Postgraduate Course on October 23, 2022, in Charlotte, North Carolina.

Dr Rizwan and colleagues noted that data on the outcome and health care costs among patients with LGIB has been scarce. The team hypothesized that, due to improved diagnostic techniques, greater access to interventional radiology, and the increased prescription of direct oral anticoagulants in recent years, the outcomes of patients presenting with LGIB from 2010 – 2019 would likely have changed.

The researchers conducted a retrospective cohort study using the National Inpatient Sample database from 2010 to 2019 of hospitalized patients whose primary discharge diagnoses indicated LGIB. The study excluded patients with concurrent upper gastrointestinal bleeding.

“We compared baseline characteristics and outcome of the patients admitted from 2010-2014 to 2015-2019 and compared change in annual trends of inpatient incidence, rates of colonoscopy, length of stay (LOS), total hospitalization charges, and all-cause mortality,” the poster noted.

A total of 1,163,385 hospitalizations with LGIB were identified, with 572,249 hospitalizations occurring from 2010 to 2014 and 591,140 during 2015-2019. The most common etiology for LGIB was diverticular bleed in both groups. Patients in the 2015-19 cohort showed lower all-cause mortality (1.00% vs 1.15%, p< 0.001) even with a higher mean Charlson comorbidity index (2.18 vs 1.69, p< 0.001).

“Over the study period, LGIB annual incidence increased with respect to hospitalizations (366.49 in 2010 to 397.95 in 2019 per 100,000 discharges, p< 0.001), the number of patients undergoing inpatient colonoscopy (51.41% in 2010 and 55.15% in 2019, p< 0.001) and inflation-adjusted total hospitalization charges was $13,826 higher in 2019 compared to 2010 (p< 0.001),” the investigators wrote. However, they noted, all-cause mortality decreased from 0.70% in 2010 to 0.59% in 2019(p=0.004).

“With more interventions and assessment are occurring and patients are sicker, the overall outcomes are improving, which is encouraging,” the authors stated. “Future research should focus on how colonoscopic assessment might be better serving to direct therapy and potentially improve outcome.”

—Rebecca Mashaw

Reference:

Rizwan R, Chaar A, Nawaz A, Feuerstadt P. A0296 - Trend analysis of lower gastrointestinal bleeding over a decade: A population-based study. Poster presentation. Poster Session A. Presented at: ACG 2022 Annual scientific meeting and Postgraduate course. Charlotte, NC. October 23, 2022.