Factors Influencing the Length of Hospital Stay in Patients With Upper Gastrointestinal Bleeding

Abstract

Introduction: Upper gastrointestinal bleeding (UGIB) represents a substantial clinical and economic burden. This condition accounts for 400,000 hospital admissions per year and cost more than $2 billion annually. The purpose of our study was to identify risk factors associated with prolonged hospital stay (Length of stay (LOS) > 4 days) in UGIB patients. Methods: We conducted the retrospective study through electronic medical record review of patients admitted at University Medical Center, Lubbock, Texas between January 2012 and March 2014. Patients older than 18 years with UGIB identified by the ICD-9 (578.9) were enrolled into the study. Admissions were excluded if patients did not have at least 30 days of follow-up or did not undergo EGD. Statistical package for social sciences (SPSSTM) version 16 was used for statistical analysis. Results: Ninety-seven patients met inclusion criteria; 36 were women (37.1%). Sixty-three patients (64.9%) were Caucasian, 23 patients (23.7%) were Hispanic, and the mean age was 59.3+15.6 years. Thirty-two patients (34%) had cirrhosis, and the mean MELD score was 13.8+5.7. Baseline characteristics were compared between 2 groups (LOS >4 days vs. LOS < 4 days) (Figure 1). Multivariate logistic regression was performed. There was a statistically significant increase in prolonged hospital stay in patients with congestive heart failure (CHF) (OR 4.62; p-value = 0.02) and delayed enteral feeding (> 24 hours after EGD) (OR 8.62; p-value = 0.01). Each point increases in Rockall score was associated with increased risk of prolonged hospital stay (OR 1.54; p-value = 0.02). There was no correlation between prolonged hospital stay and pre-endoscopic Rockall score, Glasgow-Blatchford bleeding score, cirrhosis, portal hypertension related endoscopic findings, delayed EGD (>24 hours after admission), blood product transfusion, the use of NSAIDs, antiplatelet drugs, or anticoagulants.Figure 1Conclusion: Our study demonstrates that CHF, Rockall score, and delayed enteral feeding are associated with prolonged hospital stay. Endoscopy and UGIB may compromise the cardiovascular function causing CHF exacerbation. Monitoring volume status in these patients may decrease the LOS and improve outcomes.