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Early Endoscopy Is Associated with Better Clinical Outcomes in Patients Hospitalized with Ischemic Bowel Disease

  • Olalekan AkanbiEmail author
  • Adeyinka Charles Adejumo
Original Article
  • 37 Downloads

Abstract

Background and Aims

Providing diagnostic and therapeutic interventions, lower gastrointestinal endoscopy is a salient investigative modality for ischemic bowel disease (IB). As studies on the role of endoscopic timing on the outcomes of IB are lacking, we sought to clarify this association.

Methods

After identifying 18-to-90-year-old patients with a primary diagnosis of IB from the 2012–2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we grouped them based on timing of endoscopy into three: early (n = 9268), late (n = 3515), and no endoscopy (n = 18,452). We explored the determinants of receiving early endoscopy, the impact of endoscopic timing on outcomes (mortality and 13 others), and the impact of the type of endoscopy (colonoscopy vs. sigmoidoscopy) on these outcomes among the early group (SAS 9.4).

Results

Less likely to receive early endoscopy were Blacks compared to Whites (adjusted odds ratio [aOR] 0.81 95% CI [0.70–0.94]), and individuals on Medicaid, Medicare, and uninsured compared to the privately insured group (aOR 0.80 [0.71–0.91], 0.70 [0.58–0.84], and 0.68 [0.56–0.83]). Compared to the late and no endoscopy groups, patients with early endoscopy had less mortality (aOR 0.53 [0.35–0.80] and 0.09 [0.07–0.12]), shorter length of stay (LOS, 4.64 [4.43–4.87] days vs. 8.87 [8.40–9.37] and 6.62 [6.52–7.13] days), lower total hospital cost (THC, $41,055 [$37,995–$44,361] vs. $72,598 [$66,768–$78,937] and $68,737 [$64,028–$73,793]), and better outcomes. Similarly, among those who received early endoscopy, colonoscopy had better outcomes than sigmoidoscopy for mortality, THC, LOS, and adverse events.

Conclusion

Early endoscopy, especially colonoscopy, is associated with better clinical outcomes and decreased healthcare utilization in IB. Unfortunately, there are disparities against Blacks, and non-privately insured individuals in receiving early endoscopy.

Keywords

Endoscopy Ischemic bowel disease Health outcomes Mortality Cost Length of stay 

Abbreviations

EE

Early endoscopy

LE

Late endoscopy

NE

No endoscopy

IB

Ischemic bowel disease

IC

Ischemic colitis

AKI

Acute kidney injury

LOS

Length of stay

THC

Total hospital cost

TPN

Total parenteral nutrition

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2019_5598_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Hospital Medicine, Department of MedicineUniversity of Kentucky College of MedicineLexingtonUSA
  2. 2.Department of MedicineNorth Shore Medical CenterSalemUSA
  3. 3.Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA

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