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Emergency readmission following acute upper gastrointestinal bleeding
Martin Strömdahl1, Johan Helgeson, Evangelos Kalaitzakis
1aDepartment of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden bEndoscopy Unit, Digestive Disease Center, Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark.
Insights
Emergency readmissions after acute upper gastrointestinal bleeding (AUGIB) are common, often due to rebleeding or infection. Comorbid illness predicts readmission, while bisphosphonate use and longer stays may influence rebleeding risk.
Area of Science:
- Gastroenterology
- Internal Medicine
- Public Health
Background:
- Acute upper gastrointestinal bleeding (AUGIB) is a significant cause of hospitalization.
- Understanding readmission patterns is crucial for improving patient outcomes and healthcare resource allocation.
Purpose of the Study:
- To determine the incidence of all-cause emergency readmissions following AUGIB.
- To identify clinical predictors associated with these readmissions.
- To assess the mortality rates linked to emergency readmissions after AUGIB.
Main Methods:
- A retrospective analysis of patients hospitalized for AUGIB between 2009 and 2011 in a Swedish institution.
- Data extraction included comorbidities (Charlson Comorbidity Index), medications, endoscopy findings, rebleeding events, in-hospital mortality, and 30-day emergency readmissions.
- Logistic regression was used to identify predictors of readmission and rebleeding.
Main Results:
- 16.5% of patients (174/1056) experienced a 30-day emergency readmission after discharge for AUGIB.
- Rebleeding accounted for 19% of readmissions; other causes included infections and cardiovascular events.
- Higher Charlson Comorbidity Index predicted readmission. Bisphosphonate use, prior AUGIB, and prolonged index admission stay (>5 days) predicted rebleeding.
Conclusions:
- All-cause emergency readmissions are frequent after AUGIB, with similar mortality to index admissions.
- Comorbid illness is a key predictor of readmission.
- Potentially modifiable factors like bisphosphonate use and length of stay may influence postdischarge rebleeding risk.
Objective:
To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB).
Patients And Methods:
All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009-2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated.
Results:
A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital mortality did not differ significantly between index admissions and readmissions (13.7 vs. 9.8%, P=0.181). In logistic regression analysis, only a higher Charlson comorbidity index [odds ratio (OR): 1.154, 95% confidence interval (CI): 1.056-1.261] was related to emergency readmission. Bisphosphonate use (OR: 3.933, 95% CI: 1.264-12.233), previous AUGIB (OR: 2.407, 95% CI: 1.157-5.009), and length of stay at index admission (>5 days; OR: 0.246, 95% CI: 0.093-0.649) were found to be independent predictors of postdischarge rebleeding.
Conclusion:
All-cause emergency readmission following AUGIB is frequent. It is related to rebleeding in one-fifth of cases and mortality is similar to that in index admissions. The presence of comorbid illness appears to predict readmissions. Reduced length of stay and bisphosphonate use appear to be important, potentially modifiable, predictors of postdischarge rebleeding.
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