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National Trends in the Treatment of Upper GI Bleed
Joshua S Hill, James T McPhee, Frederick A Anderson, Waheed Y Wassef, Sridhar Shankar, Demetrius E Litwin, Jennifer F Tseng
University of Massachusetts, Worcester, MA
Objective: The management of upper GI bleed (UGIB) encompasses multiple disciplines including Gastroenterology, Radiology and Surgery. This study examined, at a national level, the frequency of procedural treatment of UGIB by these specialties.
Design: Retrospective survey.
Setting: Hospital inpatients.
Patients: Nationwide Inpatient Sample (NIS), a representative all-payer database of US non-federal hospitals (1998-2003). Patients discharged with primary diagnosis of UGIB.
Interventions: 1) expectant management, 2) endoscopic control of bleeding, excluding diagnostic, 3) angiography ± endoscopy, 4) surgical treatment ± angiography/endoscopy.
Main Outcome Measure: Frequency (weighted).
Results: 1,072,307 weighted discharges (217,887 unweighted) were identified with the primary diagnosis of UGIB, including expectant management-90.1%, endoscopic control-9.5%, angio-embolization-0.1% and surgery-0.3%. Angio-embolization rates remained constant. In 1998, 4.7% of patients with UGIB were treated operatively, declining subsequently by 0.5%/year (p<0.01). Endoscopic treatment became more prevalent. In 1998, 8.7% of patients were treated by endoscopic means; by 2003 this had increased to 10% (p<0.01). Factors independently associated with surgery included congestive heart failure (OR 1.3, 95% CI 1.04-1.55), age <50 (OR 1.3, 95% CI 1.02-1.60), male sex (OR 1.3, 95% CI 1.10-1.49), private HMO versus Medicare (OR 1.3, 95% CI 1.07-1.54), and being treated in a teaching hospital (OR 1.4, 95% CI 1.20-1.71).
Conclusions: Operative treatment of UGIB has declined. The percentage of total patients with UGIB treated by surgery declined 0.5% per year; the number of patients undergoing surgery in 2003 was 1/3 fewer than in 1998. Many patients now undergo less invasive treatment modalities such as endoscopy.
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