Risk Factors for Adverse Outcomes in Patients Hospitalized With Lower Gastrointestinal Bleeding

Abstract

Objective To determine which risk factors and subtypes of lower gastrointestinal bleeding (LGIB) are associated with adverse outcomes after hospital discharge (30-day readmissions, recurrent LGIB, and death). Patients and Methods We conducted a prospective observational study of consecutive patients admitted with LGIB to Beth Israel Deaconess Medical Center from April 1, 2013, through March 30, 2014. Patients were contacted 30 days after discharge to determine hospital readmissions, recurrent LGIB, and death. Multivariable Cox proportional hazards regression models were used to describe associations of variables with 30-day readmissions or recurrent LGIB. Logistic regression was used to determine association with mortality. Results There were 277 patients hospitalized with LGIB. Of the 271 patients surviving to discharge, 21% (n=57) were readmitted within 30 days, 21 of whom were admitted for recurrent LGIB. The following factors were associated with 30-day readmissions: developing in-hospital LGIB (hazard ratio [HR], 2.26; 95% CI, 1.08–4.28), anticoagulation (HR, 1.82; 95% CI, 1.05–3.10), and active malignancy (HR, 2.33; 95% CI, 1.11–4.42). Patients discharged while taking anticoagulants had higher rates of recurrent bleeding (HR, 2.93; 95% CI, 1.15–6.95). Patients with higher Charlson Comorbidity Index scores (odds ratio [OR], 1.57; 95% CI, 1.25–2.08), active malignancy (OR, 6.57; 95% CI, 1.28–28.7), and in-hospital LGIB (OR, 11.5; 95% CI, 2.56–52.0) had increased 30-day mortality risk. Conclusion In-hospital LGIB, anticoagulation, and active malignancy are risk factors for 30-day readmissions in patients hospitalized with LGIB. In-hospital LGIB, Charlson Comorbidity Index scores, and active malignancy are risk factors for 30-day mortality.

Rates of Hospital Readmission Among Medicare Beneficiaries With Gastrointestinal Bleeding Vary Based on Etiology and Comorbidities

“…Given that readmission rates, length of stay, and mortality vary across clinical conditions, readmission reduction efforts could target specific clinical conditions more effectively than targeting a larger gastrointestinal bleeding population, particularly since clinical management differs based on the source of bleed (15–17). A potential targetable population is patients with small bowel bleeding (3.7% of all patients with gastrointestinal bleeding), who had the highest 30-day readmission rate (18.6%), but the second lowest 30-day mortality (3.%).…”

Predictors of Hospital Readmissions for Ulcerative Colitis in the United States

“…The unplanned 30-day readmission rate for upper and lower gastrointestinal bleeding in recent studies varies from 5% to 21% with the range likely attributable to differences in study populations and methods. 23–26 Thirty-day readmission rates after hospitalizations for acute pancreatitis are higher at around 20%. 27,28 Additionally, 30-day readmission rate among patients admitted for cirrhosis and related complications was 12.9% in a recent population-based study.…”

Predictors of positive endoscopic findings in hospitalized patients with occult gastrointestinal bleeding

“…10 No prior studies have evaluated risk factors for either hospital readmissions or rebleeding in patients hospitalized with anemia and occult GIB. We demonstrate that the 30-day readmission rate for patients in our cohort was 28%, with a majority of readmissions being unrelated to GIB.…”

“…As described elsewhere, 10,11 we performed a prospective observational cohort study of consecutive patients admitted with or developing GIB in the hospital. Data were collected on a total of 750 patients admitted to Beth Israel Deaconess Medical Center (BIDMC, Boston, MA, USA) from March 2013 to April 2014.…”

“…In addition, recent data have described risk factors for increased 30-day hospital readmissions and rebleeding for patients with overt GIB. 10 There is limited data on whether patients with occult bleeding have increased hospital readmission and rebleeding rates, and whether endoscopic intervention or localization during index hospitalization can reduce these rates.…”