Use and impact of early endoscopy in elderly patients with peptic ulcer hemorrhage: a population-based analysis
Received 7 August 2008; accepted 22 October 2008. published online 31 March 2009.
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.
Current affiliations: Division of Gastroenterology, University Hospitals, Case Medical Center, Cleveland, Ohio, USA
Reprint requests: Gregory S. Cooper, MD, Division of Gastroenterology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Wearn 247, Cleveland, OH 44106-5066.
DISCLOSURE: The following author received research support for this study from a Research and Outcomes and Effectiveness Award from the American Society for Gastrointestinal Endoscopy: G. S. Cooper. All other authors disclosed no financial relationships relevant to this publication.
Presented in part at Digestive Disease Week, San Diego, California, May 19, 2008. (Gastrointest Endosc 2008;67:AB88).
If you want to chat with an author of this article, you may contact him at gxc12@cwru.edu.
ABSTRACT