Use and impact of early endoscopy in elderly patients with peptic ulcer hemorrhage: a population-based analysis

Background

Upper endoscopy performed within 1 day of presentation, or early endoscopy, has been proposed as an intervention to improve the efficiency and outcomes of care for patients with peptic ulcer hemorrhage. However, the use and outcomes have not been studied in a national, U.S.-based sample.

Objective

To determine the prevalence and associated outcomes of early versus delayed endoscopy in bleeding peptic ulcers.

Design

Using a 5% random sample of inpatient and outpatient Medicare claims from 2004 in patients aged 66 years and older (mean [standard deviation] age 78.4 ± 7.7 years), we identified 2592 patients, all of whom underwent endoscopy.

Main Outcome Measurements

Univariate and multivariate models were used to determine factors associated with 30-day mortality, upper GI surgery, and length of hospital stay.

Results

Early endoscopy was performed in 1854 patients (71.5%) and was somewhat more common with outpatient management. Early endoscopy was independently associated with a significant decrease in the length of hospital stay (–1.95 days, 95% CI, –2.60 to –1.29 days) as well as a lower likelihood of surgery (odds ratio, 0.37; 95% CI, 0.21-0.66). Early endoscopy was not associated with 30-day mortality in either univariate or multivariate analyses.

Limitations

Use of claims data lacking clinical detail and restriction to the Medicare-age population.

Conclusions

In this population-based study of older patients with peptic ulcer hemorrhage, early endoscopy was associated with increased efficiency of care, lower rates of surgery, and potentially improved control of hemorrhage. Thus, unless specific contraindications exist, the data support the routine use of early endoscopy.

Abbreviations: CI, confidence interval, MEDPAR, Medicare Provider Analysis and Review, NVUGIH, nonvariceal upper GI hemorrhage