S667 Outcomes of Difficult Airway (DA) Patients Presenting With Upper Gastrointestinal Bleed (UGIB): 4-Year Retrospective Study Using National Inpatient Sample (2016 – 2019)

Abstract

Introduction: Difficult airway patients presenting with upper gastrointestinal bleeding present unique challenge due to increased risk of respiratory complications such as from aspiration or from airway obstruction during anesthesia for urgent upper endoscopy. Limited data are available regarding clinical outcomes in difficult airway patients presenting with Upper gastrointestinal bleed. Methods: Using National Inpatient Sample databases from 2016 to 2019, we identified patients presenting with Upper gastrointestinal bleed, the population were then divided based on the presence and absence of difficult airway using appropriate ICD-10-CM/PCS codes. STATA 17.0 software (3) was used for the analysis. Pearson’s Chi-Square test was used to analyze categorical variable, whereas the student t-test was used to analyze continuous variables. Univariate and multivariate logistic regression was used to adjust for potential confounders. Primary outcome was in hospital mortality due to upper gastrointestinal bleed in patients with and without difficult airway. Results: Amongst total of 1555580 patients admitted with upper gastrointestinal bleed, 140 patients had diagnosis of difficult airway and 1555440 patients did not have difficult airway diagnosis, male gender and white ethnicity was predominant in both populations. The mean LOS was 6.035±5.02 days in difficult airway group, 4.288±4.45 in non-airway group, this result was statistically significant. The mean total hospitalization charges in difficult airway group were 27111$, in the non-difficult airway group were 13183$ and this was found to be statistically significant. There were 45(32.14%) and 36708(2.36%) mortality in patients with and without difficult airway diagnosis. The difference is statistically significant with OR:5.06, 95% CI: 1.62-15.81, and p < 0.001. Odds of using IR intervention and ICU admissions were higher and EGD were lower in difficult airway group, found to be statistically significant. (Table) Conclusion: Patient with diagnosis of difficult airway presenting with upper gastrointestinal bleed symptoms were younger, had higher healthcare utilization and were associated with higher inpatient mortality and complications. Table 1. - In Patient Outcomes of the difficult intubation group presenting with upper gastrointestinal bleed Variables Odds ratio 95% CI P-value In-patient mortality 5.06 1.62-15.81 < 0.001 ALL EGD 0.425 0.131-1.378 <0.001 IR intervention 1.23 0.206-7.31 <0.001 ICU Stay 34.641 13.61-88.11 <0.001 Blood Products Transfusion 0.935 0.408-2.14 <0.001 Blakemore tube insertion 0.95 0.373-2.458 <0.001