Predictors of Unplanned Thirty-day Readmission Among Patient with Acute Lower Gastrointestinal Bleeding

Devani, Kalpit; Sonani, Hardik; Radadiya, Dhruvil; Charilaou, Paris; Brahmbhatt, Bhaumik; Patel, Pranav; Brahmbhatt, Parag; Singh, Parminderjit; Young, Mark; Reddy, Chakradhar

doi:10.14309/00000434-201810001-00548

Cited by 1 publication

(8 citation statements)

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“…Blood transfusion rates were significantly lower in the early compared to elective colonoscopy group (seven observational studies, 8,9,23,24,38,39,41 n = 1 057 016) (OR = 0.81; 95% CI: 0.75; 0.87). The number of units of blood transfused was lower in the early colonoscopy group for the sole observation study with analysable data 41 (MD = −4.30, 95% CI −6.24; −2.36).…”

Section: Resultsmentioning

confidence: 99%

“…Four RCTs 7,10,21,22 (n = 266) compared early colonoscopy done within 8 10 to 12 7 hours of presentation or within 24 hours 21,22 to standard of care or elective colonoscopy. Among observational studies (n = 1 061 281), early colonoscopy (≤24hours) was compared to elective or delayed colonoscopy (>24 hours) in 13 studies (1 prospective 36 and 12 retrospective 8,9,13,23,24,37–43 ).…”

Section: Resultsmentioning

confidence: 99%

“…The aim of this systematic review was to update existing evidence on the role of early colonoscopy in the management of patients with acute LGIB, integrating the most contemporary data, while contrasting the results from RCTs and observational studies. The timing of this work is especially important in light of the publications of many recent large observational studies, 9,23,24 two new RCTs on the topic, 21,22 and conflicting societal guidelines. 4,14 Our two meta-analyses that included the 466 patients from 4…”

Section: Discussionmentioning

confidence: 99%

Section: Blood Transfusionmentioning

confidence: 99%

“…There was a significantly shorter LOS attributable to early colonoscopy in four observational studies 8,23,39,40…”

Section: Length Of Staymentioning

confidence: 99%

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Systematic review with meta‐analysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding

Kherad

Restellini

Almadi

et al. 2020

Aliment Pharmacol Ther

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Background:The optimal timing of colonoscopy in acute lower gastrointestinal bleeding (LGIB) remains controversial.Aim: To characterise the utility of early colonoscopy (within 24 hours) in managing acute LGIB. Methods:A systematic literature search to October 2019 identified fully published articles and abstracts of randomised controlled trials (RCTs) and observational studies with control groups assessing early colonoscopy in acute LGIB. The primary outcome was rebleeding. Secondary outcomes included mortality, surgery, length of stay (LOS), definite cause of bleeding and adverse events. Odds ratios (ORs) and mean differences (MD) were calculated.Results: Of 1116 citations, 4 RCTs (466 patients) and 13 observational studies with elective colonoscopy (>24 hours) as control group (1 061 281 patients) were included.No differences in rebleeding were noted between early and elective colonoscopy groups among RCTs alone (OR = 1.70; 0.79; 3.64), or observational studies alone (OR = 1.20; 0.69; 2.09). No other significant between-group differences in outcomes were found when restricting the analysis to RCTs. Among observational studies only, early colonoscopy was associated with lower rates of all-cause mortality (OR = 0.86; 0.75; 0.98), surgery (OR = 0.52; 0.42; 0.64), blood transfusion (OR = 0.81; 0.75; 0.87), units of blood transfusion (MD = −4.30; −6.24; −2.36) and shorter LOS (MD = −1.70; −1.70; −1.70 days). Conclusion:In contradistinction to observational studies, data from RCTs do not support a role for early colonoscopy in the routine management of acute LGIB with regards to the most important clinical outcomes. Further research is needed to better identify patients with high-risk LGIB who may benefit from early colonoscopy.

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Section: Resultsmentioning

confidence: 99%