Pros and Cons of Performing Early Endoscopy in Geriatric Patients Admitted with Non-variceal Upper Gastrointestinal Bleeding: Analysis of the US National Inpatient Database

• Published in: Digestive diseases and sciences Vol. 67; no. 3; pp. 826 - 833
• Main Authors: El-Dallal, Mohammed, Walradt, Trent J., Stein, Daniel J., Khrucharoen, Usah, Feuerstein, Joseph D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2022; Springer; Springer Nature B.V
• Subjects: Age; Aged; Aged patients; Biochemistry; Blood transfusions; Comorbidity; Comparative analysis; Diagnostic imaging; Endoscopy; Endoscopy, Gastrointestinal - adverse effects; Family income; Gastroenterology; Gastrointestinal bleeding; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Geriatrics; Health aspects; Hepatology; Hospitalization; Hospitals; Humans; Inpatients; Length of Stay; Medical imaging; Medical schools; Medicine; Medicine & Public Health; Mortality; Nursing; Oncology; Original Article; Patients; Risk factors; Statistical analysis; Transplant Surgery; Esophagogastroduodenoscopy; Gastrointestinal hemorrhages; Geriatric health services; Healthcare quality
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-021-06924-4

Background
Age greater than 65 years is a well-defined risk factor for increased mortality in patients with non-variceal upper gastrointestinal bleeding (NVGIB). Endoscopy is indicated in most patients at any age but presents unique risks in the elderly cohort, and ideal timing is unclear. This study examined the association between outcomes and early (within 24 h) esophagogastroduodenoscopy (EGD) among elderly patients with NVGIB.
Methods
All patients over age 65 admitted primarily for NVGIB who underwent EGD were included from the National Inpatient Sample 2016–2017. Clinical outcomes stratified by early EGD versus late EGD were compared after adjustment for comorbidities and bleeding severity using inverse probability of treatment weighting with survey-adjusted linear and logistic regression.
Results
Out of estimated 625,530 admissions with a primary diagnosis of NVGIB, 120,835 met eligibility criteria; 24,830 underwent early EGD. Mean length of stay and total charges decreased by 1.17 days (95%CI 1.04–1.30,
P
 < 0.001) and $5717.24 (95%CI 4034.57–7399.91,
P
 < 0.001), respectively, in the early EGD group. Early EGD increased the odds ratio of death 1.32 (95%CI 1.06–1.64,
P
0.01) and transfer to other hospitals 1.48 (95%CI 1.22–1.81,
P
 < 0.001). No change was seen in the requirement for surgery or angiography. Rates of discharge to a nursing facility or home health were similar.
Conclusion
In a comprehensive cohort of geriatric patients with NVGIB, early EGD is associated with decreased hospital stay and charges, but also with increased mortality and inter-hospital transfer. Further research is needed to determine the optimal management of this vulnerable population.