P0609 - Trends and Characteristics of Hospitalizations from Dieulofoy’s Lesion: Insights from National Inpatient Sample Database 2011 to 2020

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

SP

Shanti Patel, MD

Yale University School of Medicine
New Haven, Connecticut

Shanti Patel, MD¹, Ahmad Nawaz, MD¹, AbdelKader Chaar, MD¹, Tarek Aboursheid, MD², Rabia Rizwan, MD¹, Vidhi Patel, MD³, Dhanshree Solanki, MBA, MHA⁴, Dhruv Mehta, MD⁵
¹Yale University School of Medicine, New Haven, CT; ²Ascension Saint Francis Hospital, Chicago, IL; ³Cleveland Clinic Foundation, Cleveland, OH; ⁴Rutgers University, New Brunswick, NJ; ⁵UT Health San Antonio, San Antonio, TX

Introduction: Dieulafoy’s lesion (DL) is a rare, life-threatening vascular anomaly, characterized by an abnormally large and tortuous artery along the gastrointestinal tract muscularis mucosa leading to severe gastrointestinal hemorrhage. Limited data exist regarding the annual hospitalizations and patient characteristics associated with this condition over the last decade.

Methods: A retrospective cohort study was conducted using the National Inpatient Sample (NIS) database from 2011 to 2020. All adult patients with discharge diagnoses of DL were included. The Cochrane-Armitage trend test was used to assess statistical significance in the number of hospital discharges and demographics over the study period

Results: We identified a significant increase in the number of hospital admissions with a discharge diagnosis of DL (193 vs 242 admissions per million in 2011 and 2020 respectively;P< 0.001). DL was found to be more prevalent among males. More than half of the patients with DL were older than 65 years. The majority of patients were White. Over the last decade, the rates of White patients with DL have significantly decreased (75% in 2011 to 68% in 2020;p< 0.001), while the rates of Blacks increased (11% in 2011 to 15% in 2020; p< 0.001) (Figure 1). The average adjusted total charges per hospitalization also exhibited a significant increase, rising from $50,354 in 2011 to $61,050 in 2020 (p< 0.001). (Table 1)

Discussion: The number of inpatient admissions with a diagnosis of DL has shown a consistent increase over the last decade. Improved diagnostic techniques and access to endoscopy have likely contributed to higher detection rates. Men and older patients ( >65 years-old) appear to be more susceptible to this condition. Racial disparities in admission rates were observed, with an overall higher rates among whites, however a trend emerged where white admission rates decreased and black admission rates increased. The cost of care associated with DL has also significantly risen over the last decade. Further studies are needed to understand the racial disparity in this condition.

Figure: Racial Trends and trends based on age group

	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	average	p-value
Per million	193	190	200	202	198	199	201	217	228	242	207	< 0.001
Age (years), %
18 – 34	2.43	3.25	3.37	3.30	2.75	2.11	3.41	2.79	3.42	3.33	3.02	0.416
35 – 49	7.76	6.65	6.32	6.46	8.10	8.38	7.59	7.15	6.60	8.45	7.35	0.348
50 – 64	23.75	23.34	22.07	23.79	22.75	22.61	20.88	22.94	22.40	21.32	22.59	0.132
65 – 79	36.67	37.72	37.88	37.05	39.37	40.70	41.27	40.48	40.14	41.42	39.27	< 0.001
>80	29.39	29.05	30.36	29.40	27.04	26.20	26.86	26.64	27.44	25.48	27.79	< 0.001
Gender, %
Male	54.36	56.07	56.71	57.62	56.45	57.75	53.31	56.73	56.00	57.01	56.20	0.598
Female	45.64	43.93	43.29	42.38	43.55	42.25	46.69	43.27	44.00	42.99	43.80	0.598
Race, %
White	75.06	71.74	74.22	73.53	70.1	71.18	70.85	69.24	69.79	68.65	71.44	< 0.001
Black	11.44	13.75	13.11	12.94	15.1	14.12	14.5	16.88	14.55	15.58	14.20	< 0.001
Hispanic	7.82	7.10	7.15	7.65	7.66	8.24	7.97	7.97	8.34	8.71	7.86	0.067
Other	5.68	7.41	5.51	5.89	7.15	6.47	6.68	5.92	7.30	7.07	6.50	0.153
Hospital region, %
Northeast	20.12	19.94	17.92	18.67	19.3	18.66	18.16	18.19	17.86	18.25	18.71	0.103
Midwest	23.55	23.41	21.93	23.09	22.18	21.27	22.48	23.98	24.39	21.7	22.80	0.776
South	37.64	36.42	36.89	36.70	37.32	37.39	38.48	38.34	36.22	35.85	37.13	0.594
West	18.70	20.23	23.26	21.54	21.20	22.68	20.88	19.49	21.53	24.20	21.37	0.013
Hospital location and teaching status, %
Rural	8.22	9.18	8.01	6.25	6.83	4.93	6.12	5.07	5.41	4.35	6.44	< 0.001
Urban nonteachting	39.42	37.28	40.90	27.51	27.82	25.56	20.60	19.10	17.67	16.20	27.21	< 0.001
Urban teaching	52.36	53.54	51.09	66.25	65.35	69.51	73.28	75.83	76.91	79.45	66.36	< 0.001
Median household income, %
Quartile 1	26.65	29.00	25.43	28.22	29.36	29.76	28.99	27.64	27.55	24.64	27.72	0.484
Quartile 2	24.33	23.39	26.43	25.41	24.00	25.52	26.93	28.69	26.35	30.25	26.13	< 0.001
Quartile 3	26.00	23.69	27.65	26.42	24.36	23.29	23.39	24.21	23.52	24.12	24.67	0.015
Quartile 4	23.02	23.91	20.49	19.94	22.29	21.42	20.69	19.46	22.58	20.99	21.48	0.147
Bedsize of hospital, %
Small	10.34	10.84	12.30	16.77	13.24	14.58	16.01	17.74	16.55	17.03	14.54	< 0.001
Medium	25.44	26.23	26.42	28.35	31.34	30.07	29.51	30.15	29.99	29.45	28.70	< 0.001
Large	64.22	62.93	61.28	54.88	55.42	55.35	54.49	52.11	53.45	53.52	56.77	< 0.001
Total Charges ($), Median	50,354	49,072	51,373	54,023	51,044	53,064	54,796	60,648	56,195	61,050	54,177	< 0.001

Table: Table 1

Disclosures:

Shanti Patel indicated no relevant financial relationships.

Ahmad Nawaz indicated no relevant financial relationships.

AbdelKader Chaar indicated no relevant financial relationships.

Tarek Aboursheid indicated no relevant financial relationships.

Rabia Rizwan indicated no relevant financial relationships.

Vidhi Patel indicated no relevant financial relationships.

Dhanshree Solanki indicated no relevant financial relationships.

Dhruv Mehta indicated no relevant financial relationships.

Shanti Patel, MD¹, Ahmad Nawaz, MD¹, AbdelKader Chaar, MD¹, Tarek Aboursheid, MD², Rabia Rizwan, MD¹, Vidhi Patel, MD³, Dhanshree Solanki, MBA, MHA⁴, Dhruv Mehta, MD⁵. P0609 - Trends and Characteristics of Hospitalizations from Dieulofoy’s Lesion: Insights from National Inpatient Sample Database 2011 to 2020, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.