Ann Roy1, Micheline Kim1, Robert Hawes2, Shyam Varadarajulu2. 1. Health Economics and Reimbursement, Boston Scientific Corporation, Natick, MA, USA. 2. Center for Interventional Endoscopy, Florida Hospital, Orlando, FL, USA.
Abstract
AIM: The aim of this article is to evaluate the clinical and cost implications of failed endoscopic hemostasis in patients with gastroduodenal ulcer bleeding. METHODS: A retrospective claims analysis of the Medicare Provider Analysis and Review (MedPAR) file was conducted to identify all hospitalizations for gastroduodenal ulcer bleeding in the year 2012. The main outcome measures were to compare all-cause mortality, total length of hospital stay (LOS), hospital costs and payment between patients managed with one upper gastrointestinal (UGI) endoscopy versus more than one UGI endoscopy or requiring interventional radiology-guided hemostasis (IRH) or surgery after failed endoscopic attempt. RESULTS: The MedPAR claims data evaluated 13,501 hospitalizations, of which 12,242 (90.6%) reported one UGI endoscopy, 817 (6.05%) reported >1 UGI endoscopy, 303 (2.24%) reported IRH after failed endoscopy and 139 (1.03%) reported surgeries after failed endoscopy. All cause-mortality was significantly lower for patients who underwent only one UGI endoscopy (3%) compared to patients requiring >1 endoscopy (6%), IRH (9%) or surgery (14%), p < 0.0001. The median LOS was significantly lower for patients who underwent only one UGI endoscopy (four days) compared to patients requiring >1 endoscopy (eight days), IRH (nine days) or surgery (15 days), p < 0.0001. The median hospital costs were significantly lower for patients who underwent one UGI endoscopy ($10,518) compared to patients requiring >1 endoscopy ($20,055), IRH ($34,730) or surgery ($47,589), p < 0.0001. CONCLUSIONS: Failure to achieve hemostasis at the index endoscopy has significant clinical and cost implications. When feasible, a repeat endoscopy must be attempted followed by IRH. Surgery should preferably be reserved as a last resort for patients who fail other treatment measures.
AIM: The aim of this article is to evaluate the clinical and cost implications of failed endoscopic hemostasis in patients with gastroduodenal ulcer bleeding. METHODS: A retrospective claims analysis of the Medicare Provider Analysis and Review (MedPAR) file was conducted to identify all hospitalizations for gastroduodenal ulcer bleeding in the year 2012. The main outcome measures were to compare all-cause mortality, total length of hospital stay (LOS), hospital costs and payment between patients managed with one upper gastrointestinal (UGI) endoscopy versus more than one UGI endoscopy or requiring interventional radiology-guided hemostasis (IRH) or surgery after failed endoscopic attempt. RESULTS: The MedPAR claims data evaluated 13,501 hospitalizations, of which 12,242 (90.6%) reported one UGI endoscopy, 817 (6.05%) reported >1 UGI endoscopy, 303 (2.24%) reported IRH after failed endoscopy and 139 (1.03%) reported surgeries after failed endoscopy. All cause-mortality was significantly lower for patients who underwent only one UGI endoscopy (3%) compared to patients requiring >1 endoscopy (6%), IRH (9%) or surgery (14%), p < 0.0001. The median LOS was significantly lower for patients who underwent only one UGI endoscopy (four days) compared to patients requiring >1 endoscopy (eight days), IRH (nine days) or surgery (15 days), p < 0.0001. The median hospital costs were significantly lower for patients who underwent one UGI endoscopy ($10,518) compared to patients requiring >1 endoscopy ($20,055), IRH ($34,730) or surgery ($47,589), p < 0.0001. CONCLUSIONS: Failure to achieve hemostasis at the index endoscopy has significant clinical and cost implications. When feasible, a repeat endoscopy must be attempted followed by IRH. Surgery should preferably be reserved as a last resort for patients who fail other treatment measures.
Entities:
Keywords:
Peptic ulcer bleeding; costs; endoscopy; interventional radiology; outcomes; surgery
Authors: Tiffany C L Wong; Ka-Tak Wong; Philip W Y Chiu; Anthony Y B Teoh; Simon C H Yu; Kim W L Au; James Y W Lau Journal: Gastrointest Endosc Date: 2011-02-02 Impact factor: 9.427
Authors: Sarah A Hearnshaw; Richard F A Logan; Derek Lowe; Simon P L Travis; Mike F Murphy; Kelvin R Palmer Journal: Gut Date: 2011-04-13 Impact factor: 23.059
Authors: J Y Lau; J J Sung; Y H Lam; A C Chan; E K Ng; D W Lee; F K Chan; R C Suen; S C Chung Journal: N Engl J Med Date: 1999-03-11 Impact factor: 91.245
Authors: H Messmann; P Schaller; T Andus; G Lock; W Vogt; V Gross; H Zirngibl; K H Wiedmann; T Lingenfelser; K Bauch; H G Leser; J Schölmerich; A Holstege Journal: Endoscopy Date: 1998-09 Impact factor: 10.093
Authors: B Joseph Elmunzer; Scott D Young; John M Inadomi; Philip Schoenfeld; Loren Laine Journal: Am J Gastroenterol Date: 2008-08-05 Impact factor: 10.864
Authors: Joseph J Y Sung; Kelvin K F Tsoi; Terry K W Ma; Man-Yee Yung; James Y W Lau; Philip W Y Chiu Journal: Am J Gastroenterol Date: 2009-09-15 Impact factor: 10.864