S653 Trend Analysis of Lower Gastrointestinal Bleeding Over a Decade: A Population-Based Study

Abstract

Introduction: There is scarcity of data available on the outcome and healthcare cost in patients with lower gastrointestinal bleeding (LGIB) over the past decade. Given improved diagnostic techniques, more access to interventional radiology procedures and increased prescription of direct oral anticoagulants in comparison to the years prior to that we hypothesized that these changes impacted the outcomes of patients presenting to hospitals with LGIB from 2010 – 2019. Methods: We performed a retrospective cohort study using the National Inpatient Sample database from 2010 to 2019 of hospitalized patients with primary discharge diagnoses indicating LGIB. Patients with concurrent upper gastrointestinal bleed were excluded. We compared baseline characteristics and outcome of the patients admitted from 2010-2014 to 2015-2019 and compared change in annual trends of inpatient incidence, rates of colonoscopy, length of stay (LOS), total hospitalization charges, and all-cause mortality. We applied discharge weights to generate national estimates (Figure). Results: A total of 1,163,385 hospitalizations with LGIB were identified; 572,249 hospitalizations during 2010 – 14 and 591,140 during 2015-19. Diverticular bleed remained the most common etiology of LGIB hospitalizations in both groups. The 2015-19 patients had a lower all-cause mortality (1.00% vs 1.15%, p< 0.001) despite a higher mean Charlson co-morbidity index (2.18 vs 1.69, p< 0.001). Over the study period, LGIB annual incidence increased with respect to hospitalizations (366.49 in 2010 to 397.95 in 2019 per 100,000 discharges, p< 0.001), the number of patients undergoing inpatient colonoscopy (51.41% in 2010 and 55.15% in 2019, p< 0.001) and inflation-adjusted total hospitalization charges was $13,826 higher in 2019 compared to 2010 (p< 0.001), however there was decrease in all-cause mortality (0.70% in 2010 to 0.59% in 2019, p=0.004) (Table). Conclusion: Over the past decade, the rate of inpatient colonoscopy has increased and despite increase in incidence, the inpatient mortality rate is decreasing in patients admitted with LGIB. With more interventions and assessment are occurring and patients are sicker, the overall outcomes are improving which is encouraging. Future research should focus on how colonoscopic assessment might be better serving to direct therapy and potentially improve outcome.Figure 1.: Trends of incidence, length of stay, cost of hospitalization, rates of colonoscopy and all-cause mortality rate for lower gastrointestinal bleeding over a decade. Table 1. - Yearly adjusted rates (or means) for important outcomes Colonoscopy Length of Stay (Days) Total Charges ($) LGIB Incidence (per 100,000 discharges) Mortality 2010 51.41% 4.03 $31,345.01 366.49 0.70% 2011 51.83% 4.02 $32,881.24 369.86 0.69% 2012 52.25% 4.01 $34,417.46 373.26 0.68% 2013 52.66% 4.00 $35,953.68 376.69 0.66% 2014 53.08% 3.99 $37,489.90 380.15 0.65% 2015 53.50% 3.99 $39,026.12 383.65 0.64% 2016 53.91% 3.98 $40,562.35 387.17 0.62% 2017 54.33% 3.97 $42,098.57 390.73 0.61% 2018 54.74% 3.96 $43,634.79 394.32 0.60% 2019 55.15% 3.95 $45,171.01 397.95 0.59% p-trend p< 0.001 p=0.040 p< 0.001 P< 0.001 p=0.004