Determinants of Duration of Hospital Stay in Patients with Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB) According to Patient Outcomes

Abstract

Introduction: Length of stay (LOS) is the greatest determinant of costs related to the management of patients with non variceal upper gastrointestinal bleeding (NVUGIB). However, robust contemporary predictors of LOS in the era of profound acid suppression remain poorly characterized. Aim: To identify clinically relevant independent predictors of LOS in patients with acute NVUGIB according to patient outcomes. Methods: The Canadian Registry of patients with Upper Gastrointestinal Bleeding undergoing Endoscopy (RUGBE) is a multi-center 217 variables database collected on 1869 patients with NVUGIB in Canada between 1999 and 2002. Extensive data collection and validation methods were carried out. Linear regression models were constructed to determine whether predictors of length of stay (LOS), the dependent variable, differ among patients with a) an uncomplicated NVUGIB, b) rebleeding or c) death. Clinically relevant variables relating to patient characteristics prior to discharge or death were assessed as possible independent predictors of LOS. Results: The study population consisted of 1500 patients who underwent gastroscopy within 48 hours. Clinical and process variables associated with LOS in patients with a complicated (rebleeding and death) and uncomplicated NVUGIB are presented (Table 1 and 2). Conclusions: These results suggest that LOS is influenced by the process of care and modified by the natural history of NVUGIB. Indeed, when adjusted for other covariates, endoscopic diagnosis appears to have little impact on LOS. These results suggest that a better selection of patients with acute NVUGIB may optimize the benefits attributable to early endoscopy. Table 1Predictors of LOS in patients with uncomplicated NVUGIB Variables Coefficients & 95% CI (days) ASA III (I–V) β = 2.12 (1.01, 3.23) ASA IV (I-V) β = 2.94 (1.51, 4.36) Number of endoscopic procedures β = 1.66 (0.92, 2.38) Interval from onset of bleeding to endoscopy (10 hour) β = −0.3 (−0.5, −0.02) Open table in a new tab Table 2Predictors of LOS/survival in NVUGIB patients with a complicated course Subgroup Variables Coefficients & 95% CI (days) Reebleding ASA III (I-V) β = 5.1, (0.19, 10.03) ASA IV (I-V) β = 10.05 (4.71, 15.39) ASA V (I-V) β = 18.27 (2.00, 34.53) Number of endoscopic procedures β = 2.71 (1.53, 3.88) Death Endoscopy performed after working hours β = 10.35 (3.30, 17.39) Clean-based ulcer β = 12.35 (4.82, 19.88) Negative NTG aspirate β = −14.43 (−25.72, −3.14) Initial fluid resuscitation β = −8.80 CI (−16.90, −0.69) Open table in a new tab