P0593 - Impact of Inter-Hospital Transfer Status on Outcomes of Variceal and Non-Variceal Upper Gastrointestinal Bleeding: Analysis From National Inpatient Sample

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

AJ

Ali Jaan, MD

Rochester General Hospital
Rochester, NY

Ali Jaan, MD¹, Umer Farooq, MD¹, Sheza Malik, MD¹, Chengu Niu, MD¹, Ahmed Shehadah, MD¹, Le Yu Naing, MD², Nida Khalid, MD¹, Karin Dunnigan, MD¹, Patrick Okolo, MD, MPH, FACG¹
¹Rochester General Hospital, Rochester, NY; ²University of Louisville, Louisville, KY

Introduction: Upper gastrointestinal bleeding (UGIB) is a significant healthcare concern, and its epidemiology and outcomes have evolved over the years. This study aimed to assess the impact of interhospital transfer on the outcomes of variceal UGIB (VUGIB) and non-variceal UGIB (NVUGIB).

Methods: Using the National Inpatient Sample 2017-2020 and International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10- CM) codes, we identified adult patients (aged ≥18 years) who were admitted with a principal diagnosis of VUGIB and NVUGIB. We compared the outcomes between transferred and non-transferred patients and used multivariate regression models to control for potential confounding variables. STATA 14.2 was utilized for statistical analysis.

Results: We included a total of 161,929 adult patients admitted for UGIB, of which 96.5% (156,274) had NVUGIB and 3.5% (5,655) had VUGIB (Table 1). We observed statistically significant higher odds of mortality (adjusted odds ratio [aOR] 1.86, P< 0.01), initiation of total parenteral nutrition (aOR 1.81, P< 0.01), acute kidney injury requiring dialysis (AKId) (aOR 1.76, P< 0.01), requirement for mechanical ventilation (aOR 2.02, P< 0.01) & vasopressors (aOR 2.37, P< 0.01), intensive care unit (ICU) admission (aOR 2.01, P< 0.01), need for esophagogastroduodenoscopy (EGD) with interventions (aOR 1.10, P< 0.01), and interventional radiology (IR)-guided embolization (aOR 2.01, P< 0.01) in transferred NVUGIB patients than in non-transferred patients. In patients with VUGIB, we found no difference in mortality between transferred and non-transferred patients. However, similar to NVUGIB, we observed significantly higher odds of AKId (aOR 3.79, P = 0.01), mechanical ventilation (aOR 1.73, P< 0.01), vasopressor requirement (aOR 2.13, P< 0.01), and ICU admission (aOR 1.76, P< 0.01) in transferred VUGIB patients. Also, a higher proportion of transferred patients with VUGIB underwent transjugular intrahepatic portosystemic shunt (TIPS) (aOR 3.26, P< 0.01). Further, regardless of the cause of UGIB, transferred patients had significantly longer hospital stays and higher costs than non-transferred patients.

Discussion: Our study found that transferred patients with NVUGIB and VUGIB had a higher risk of adverse outcomes than non-transferred patients. The literature comparing the outcomes of UGIB based on patient transfer status is limited; therefore, further studies are required to validate our findings.

Outcomes (n=161,929)	NVUGIB + age >18 y = 156,274			VUGIB + age >18 y = 5,655
Outcomes (n=161,929)	Not transferred from another hospital (n=136, 827)	Transferred from another hospital (n=12,994)	*Adjusted OR (95% CI; p-value)	Not transferred from another hospital (n=4,949)	Transferred from another hospital (n=578)		**Adjusted OR (95% CI; p-value)
Mortality, %	1.60	3.40	1.86 (1.65 – 2.09; < 0.01)	4.82	8.19		1.41 (0.97 – 2.06; 0.08)
Total parenteral nutrition, %	0.45	0.92	1.81 (1.45 – 2.27; < 0.01)	0.18	0.35		1.58 (0.30 – 8.38; 0.59)
Vasopressor requirement, %	0.87	2.46	2.37 (2.02 – 2.78; < 0.01)	1.62	3.83		2.13 (1.26 – 3.62; < 0.01)
Mechanical ventilation, %	3.61	7.99	2.02 (1.86 – 2.20; < 0.01)	12.48	22.26		1.73 (1.35 – 2.21; < 0.01)
Requiring ICU admission, %	4.08	8.92	2.01 (1.86 – 2.18; < 0.01)	12.97	23.13		1.76 (1.38 – 2.24; < 0.01)
Septic shock, %	0.60	1.32	2.03 (1.69 – 2.44; < 0.01)	0.77	1.91		1.87 (0.87 – 4.05; 0.11)
Hemorrhagic shock, %	3.41	4.77	1.31 (1.20 – 1.44; < 0.01)	5.70	5.39		0.88 (0.56 – 1.37; 0.56)
AKI, %	23.05	25.22	1.08 (1.03 – 1.13; 0.01)	19.42	21.91		1.17 (0.91 – 1.49; 0.23)
AKI requiring dialysis, %	0.53	1.02	1.76 (1.43 – 2.17; < 0.01)	0.39	1.57		3.79 (1.35 – 10.63; 0.01)
Blood transfusion, %	38.49	27.73	0.63 (0.58 – 0.67; < 0.01)	40.13	25.91		0.58 (0.47 – 0.72; < 0.01)
Diagnostic EGD without intervention, %	68.88	62.44	0.77 (0.74 – 0.80; < 0.01)	30.34	27.83		1.01 (0.82 – 1.24; 0.93)
EGD with intervention, %	33.91	37.58	1.10 (1.05 – 1.15; < 0.01)	59.83	56.70		0.81 (0.66 – 0.98; 0.03)
Any EGD, %	90.07	87.35	0.70 (0.66 – 0.75; < 0.01)	80.17	74.61		0.72 (0.57 – 0.90; < 0.01)
Repeat EGD during index hospitalization, %	29.80	28.40	0.95 (0.90 – 1.00; 0.05)	18.96	22.38		1.29 (0.98 – 1.68; 0.07)
Radiography-guided embolization	0.88	2.14	2.01 (1.73 – 2.34; < 0.01)	-	-		-
TIPS	-	-	-	1.38	4.87		3.26 (1.92 – 5.54; < 0.01)
Adjusted Mean Difference
Mean Length of hospital stay, days (95% CI)	4.42 (4.40 - 4.45)	5.5 (5.42 - 5.65)	0.95 (0.82 – 1.07; < 0.01)	4.50 (4.39 - 4.61)	5.25 (4.83 - 5.67)	0.45 (0.04 – 0.85; 0.03)
Total Hospitalization Charges, mean, USD	54,839 (54,158 – 55,520)	61,755 (59,431 -64,079)	3,754 (1,556 – 5,953; < 0.01)	61,354 (59,457 - 63,250)	68,613 (61,064 -76,161)	5,677 (-2240 – 13,595; 0.16)

Table: Table 1: Unadjusted and adjusted outcomes of UGIB hospitalizations stratified by inter-hospital transfer status.
*Adjusted for sex, age, hospital bed size, Charlson index, hospital location, insurance status, race, anticoagulant use, ESRD, cirrhosis, obesity, thrombocytopenia, and coagulopathy.
**Adjusted for sex, age, Charlson index, hospital bed size, hospital region, insurance status, race, anticoagulant use, ESRD, obesity, thrombocytopenia, coagulopathy, hepatocellular carcinoma, ascites, malnutrition, hepatic encephalopathy, hyponatremia, hepatorenal syndrome, and spontaneous bacterial peritonitis.
Abbreviation- NVUGIB: nonvariceal Upper GI Bleed; VUGIB: variceal upper GI bleed; OR: Odds ratio; CI: confidence interval; AKI: Acute Kidney Injury; ESRD: End-stage renal disease; EGD: esophagogastroduodenoscopy; ICU: intensive care unit; TIPS: Trans jugular intrahepatic portosystemic shunt.

Disclosures:

Ali Jaan indicated no relevant financial relationships.

Umer Farooq indicated no relevant financial relationships.

Sheza Malik indicated no relevant financial relationships.

Chengu Niu indicated no relevant financial relationships.

Ahmed Shehadah indicated no relevant financial relationships.

Le Yu Naing indicated no relevant financial relationships.

Nida Khalid indicated no relevant financial relationships.

Karin Dunnigan indicated no relevant financial relationships.

Patrick Okolo indicated no relevant financial relationships.

Ali Jaan, MD¹, Umer Farooq, MD¹, Sheza Malik, MD¹, Chengu Niu, MD¹, Ahmed Shehadah, MD¹, Le Yu Naing, MD², Nida Khalid, MD¹, Karin Dunnigan, MD¹, Patrick Okolo, MD, MPH, FACG¹. P0593 - Impact of Inter-Hospital Transfer Status on Outcomes of Variceal and Non-Variceal Upper Gastrointestinal Bleeding: Analysis From National Inpatient Sample, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.