Obesity Impacts Resource Utilization but Not Mortality Among Patients Admitted With Lower Gastrointestinal Hemorrhage: A Nationwide Analysis

Abstract

Introduction: Obesity is associated with worse outcomes in multiple medical conditions including myocardial infarction and nosocomial infections. The relationship between obesity and lower gastrointestinal hemorrhage (LGIH) in hospitalized patients has not been previously evaluated. Our aim was to determine the impact of obesity on in-hospital mortality, other important clinical outcomes and resource utilization for patients with LGIH. Methods: This was a retrospective cohort study using the 2012 Nationwide Inpatient Sample (NIS) database, the largest publically available and nationally representative inpatient database in the United States. Discharges were included if they were 18 years of age or older, were emergent and had a principle ICD-9 CM code indicating a LGIH. The primary outcome was in-hospital mortality; secondary outcomes were hemorrhagic shock, intensive care unit (ICU) admission and resource utilization: in-hospital colonoscopy, endoscopic treatment, CT scan of the abdomen, angiography, length of stay (LOS), time to colonoscopy and total hospitalization charges. Odds ratios (OR) and means were adjusted for the following confounders using multivariate regression analyses: age, gender, race, weekend admission, median income in patient's zip code, comorbidities (Charlson index), hospital region, rural/urban location, teaching status and size. Results: 163,370 discharges with LGIH were included in the study, 16,795 (10%) of whom were obese. Overall, in-hospital mortality from LGIH was 1.03%. All adjusted ORs, adjusted means and p-values are shown in Table 1. On multivariate analysis, the adjusted odds of in-hospital mortality were similar for obese and non-obese patients. In addition, both groups had similar rates of hemorrhagic shock and ICU admission. However, obese patients were more likely to have an in-hospital colonoscopy, although the rates of colonoscopic intervention were similar between both groups. Looking at resource utilization, obese patients had a longer LOS despite similar time to colonoscopy compared with non-obese patients, more CT scans of the abdomen, and higher total hospitalization charges compared with non-obese patients.Table 1: Study Outcomes for Obese vs. Non-Obese PatientsConclusion: Obesity has no effect on in-hospital mortality in patients with LGIH. However, despite similar rate of hemorrhagic shock, ICU admission and time to colonoscopy, resource utilization (colonoscopy, LOS and CT scans) was significantly higher for obese patients, leading to a significant increase in total hospitalization charges.