Nathan Schmulewitz1, Deborah A Fisher, Don C Rockey. 1. Gastroenterology Division, Duke Liver Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Abstract
BACKGROUND: Appropriate management of lower-GI hemorrhage remains controversial largely because outcomes data are lacking. It is our hypothesis that clinical factors, such as comorbidity, hemodynamic instability, and timing of colonoscopy, are associated with hospital lengths of stay. METHODS: Medical records of patients hospitalized for lower-GI hemorrhage from 1993 to 2000 were reviewed and abstracted, and a Cox regression model was constructed to explore associations between time to discharge (i.e., length of stay) and clinical parameters. RESULTS: A total of 565 hospitalizations for acute lower-GI hemorrhage were examined in which mean length of stay was 6.7 days. Colonoscopy was performed during 415 hospitalizations. Approximately a third of patients were discharged within 48 hours after colonoscopy. In the regression model, hemodynamic instability, higher comorbidity, performance of a tagged red blood cell nuclear scan, and surgery for hemostasis were significantly associated with a decreased likelihood of discharge. Having a colonoscopy was associated with an increased likelihood of being discharged compared with not having a colonoscopy at any given time point during hospitalization (hazard ratio 1.5: 95% CI[1.2, 1.8]. The mean lengths of stay for patients having colonoscopy within 24 hours of hospitalization was shorter than those having colonoscopy after 24 hours of hospitalization (5.4 vs. 7.2 days; p<0.008). CONCLUSIONS: In patients with lower-GI hemorrhage, earlier colonoscopy predicted earlier hospital discharge. However, colonoscopy did not necessarily lead to expedited post-procedural discharge. Although early colonoscopy appears to shorten hospital length of stay, prospective studies of inpatient colonoscopy are needed to determine the impact of this approach on outcomes.
BACKGROUND: Appropriate management of lower-GI hemorrhage remains controversial largely because outcomes data are lacking. It is our hypothesis that clinical factors, such as comorbidity, hemodynamic instability, and timing of colonoscopy, are associated with hospital lengths of stay. METHODS: Medical records of patients hospitalized for lower-GI hemorrhage from 1993 to 2000 were reviewed and abstracted, and a Cox regression model was constructed to explore associations between time to discharge (i.e., length of stay) and clinical parameters. RESULTS: A total of 565 hospitalizations for acute lower-GI hemorrhage were examined in which mean length of stay was 6.7 days. Colonoscopy was performed during 415 hospitalizations. Approximately a third of patients were discharged within 48 hours after colonoscopy. In the regression model, hemodynamic instability, higher comorbidity, performance of a tagged red blood cell nuclear scan, and surgery for hemostasis were significantly associated with a decreased likelihood of discharge. Having a colonoscopy was associated with an increased likelihood of being discharged compared with not having a colonoscopy at any given time point during hospitalization (hazard ratio 1.5: 95% CI[1.2, 1.8]. The mean lengths of stay for patients having colonoscopy within 24 hours of hospitalization was shorter than those having colonoscopy after 24 hours of hospitalization (5.4 vs. 7.2 days; p<0.008). CONCLUSIONS: In patients with lower-GI hemorrhage, earlier colonoscopy predicted earlier hospital discharge. However, colonoscopy did not necessarily lead to expedited post-procedural discharge. Although early colonoscopy appears to shorten hospital length of stay, prospective studies of inpatient colonoscopy are needed to determine the impact of this approach on outcomes.
Authors: Parit Mekaroonkamol; Kimberly Jegel Chaput; Young Kwang Chae; Michael L Davis; Pojnicha Mekaroonkamol; Sherry Pomerantz; Philip O Katz Journal: World J Gastrointest Endosc Date: 2013-02-16