Cost analysis of outpatient management versus hospitalization in patients diagnosed of upper gastrointestinal hemorrhage not associated with portal hypertension

Abstract

Antecedents: In accord with objective criteria, outpatient management of upper gastrointestinal hemorrhage (UG1H) is a safe alternative to hospitalization, so it may save in terms of hospital costs. Aim: To compare the costs between outpatient management vs. hospitalization in patients with UGIH with similar clinical and endoscopic features. Patients and Methods: Two groups of patients with UG1H not associated with portal hypertension, who were prospectively evaluated at Emergency, were included: 150 admitted at hospital (HG) and 150 that were early discharge (OG). At Emergency, all patients were examined by a gastroenterologist: hemodynamic status, clinical history, laboratory tests and shortly endoscopy (before 8 hours in OG). In accord with specific guidelines, patients with any criterion for hospitalization were not included (severe heart failure; recent myocardial or cerebrovascular accident; severe coagulopathy; unsuitable family conditions; severe hemodynamic repercussion; endoscopy stigmata of recent bleeding; impossibility of performing endoscopy), as well as recurrent hemorrhage, surgery or death. Features of both groups were compared: clinical (comorbidy, alcohol/NSAlDs/anticoagulants use, symptoms, hemodypamic status); biological ; endoscopic findings (cause and severity of UGIH), need of blood transfusion and eradication therapy. Cost analysis were obtained by comparison between groups of cost data of Emergency stay, hospital stay, diagnostic procedures, hospital and outpatient therapy and clinic visit on four weeks after discharge. Results: No statistical differences between groups when clinical, hemodynamic, biological variables and transfusion were compared (p>0.05, ChiSquare test). Endoscopy was not performed in 9 patients of HG because negative and no endoscopic findings were detected in 16 of OG. The remaining (141 HG and 134 OG) presented blackish rests or lesion without stigmata. Mean of hospital stay was of 3.05 + 2.13 days in HG, whereas all patients of the OG were discharge at Emergency in <24 hours. Mean costs were of $ 970 + 428 for HG and $ 370 + 71 for OG (p<0.O01, Sntdent-t test). Room costs accounted for difference in total costs. Conclusion: In accord with specific guidelines that depends on clinical and endoscopic criteria, outpatient management of upper gastrointestinal hemorrhage not associated with portal hypertension is safe and produce significant savings in hospital costs