Ahmed A. Elkafrawy, MD1, Hasan F. Othman, MD2, Yousaf Zafar, MD3, Badar Hasan, MD4, Fredy Nehme, MD3, Laith Numan, MD1
1University of Missouri Kansas City School of Medicine, Kansas City, MO; 2Cleveland Clinic, Lansing, MI; 3University of Missouri, Kansas City, MO; 4Cleveland Clinic Foundation, Weston, FL
Introduction: GI bleeding is a life-threatening GI emergency with a major burden for the health care system in the US. The aim of this study is to evaluate the impact of teaching status of the hospital on the outcomes of hospitalized patients with GI bleeding.
Methods: Nationwide Inpatient Sample database (NIS) was queried to identify patients hospitalized between 2006 and 2015 with GI bleeding using (ICD9-CM) codes. Patients were classified into 2 groups according to the teaching status of the admission hospital to either teaching or non-teaching hospitals. Both groups were compared regarding age, gender, race, mortality, undergoing GI endoscopy (EGD, small intestinal endoscopy, flexible sigmoidoscopy or colonoscopy), outcomes and commonly associated comorbidities. Statistical analysis was performed using SPSS V.25.
Results: We identified 8,211,580 patients admitted with GI bleeding between 2006-2015. Out of them, 3,826,532 patients were admitted to teaching hospitals while 4,385,049 patients were admitted to non-teaching hospitals. Median (IQR) age in patients admitted to teaching hospitals was 67 (53-79) years compared to 71 (56-81) years in non-teaching hospitals. 53.1% of patients admitted to teaching hospitals were males compared to 49.9% in the non-teaching hospitals. GI endoscopy was performed in 46.6% of patients admitted to teaching hospitals compared to 46.1% in non-teaching hospitals (95% CI 1.01, 1.02), (P < 0.001). Patients admitted to teaching hospitals had higher mortality (7.3 %) compared to (6.1%) in non-teaching hospitals (95% CI 1.21, 1.22), (P < 0.001). The median length of stay was 4 days in both groups. Shock was present in 7.7% of patients admitted to teaching hospitals compared to 5.3% in patients in non-teaching hospitals (95% CI-1.46-1.48), (P < 0.001). 9.8% of patients with GI bleeding admitted to teaching hospitals were mechanically ventilated compared to 6.5% in non-teaching hospitals (95% CI 1.55-1.57), (P < 0.001). Blood transfusions were administered to 38.5 % of patients admitted to teaching hospital compared to 41.9% of patients in non-teaching hospitals (95% CI 0.86-0.87) (P< 0.001).
Discussion: 46 % of patients with GI bleeding between 2006-2015 were admitted to teaching hospitals. Admission to a teaching hospital was associated with higher mortality, higher number of endoscopies, higher likelihood of shock and mechanical ventilation but less blood transfusion. Results likely indicate higher level of acuity and complexity of patients admitted to teaching hospitals.
Citation: Ahmed A. Elkafrawy, MD; Hasan F. Othman, MD; Yousaf Zafar, MD; Badar Hasan, MD; Fredy Nehme, MD; Laith Numan, MD. P2223 - IMPACT OF HOSPITAL TEACHING STATUS ON THE OUTCOMES OF GI BLEEDING HOSPITALIZATIONS IN THE U.S.: INSIGHTS FROM THE NATIONAL DATABASE. Program No. P2223. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.