Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage

Area of Science:

• Gastroenterology
• Emergency Medicine
• Clinical Outcomes Research

Background:

• Upper gastrointestinal hemorrhage (UGIH) is a common medical emergency.
• Timely endoscopic intervention is crucial for managing UGIH.
• The impact of delayed endoscopy on patient mortality requires further investigation.

Purpose of the Study:

• To determine the association between delayed endoscopy (>24 hours) and hospital mortality in patients with UGIH.
• To evaluate the effect of endoscopy timing on intensive care unit admission, emergency department length of stay, and hospital length of stay.

Main Methods:

• Retrospective analysis of adult UGIH patients undergoing endoscopy over two years.
• Primary exposure: endoscopy performed >24 hours after emergency department visit.
• Primary outcome: all-cause hospital mortality; secondary outcomes: ICU admission, ED and hospital length of stay.

Main Results:

• 1101 patients analyzed; 203 (18.4%) had delayed endoscopy (>24 hours).
• Hospital mortality was higher in the delayed group (6.4%) compared to the early group (2.8%) (adjusted RR 2.23, p=0.013).
• Delayed endoscopy was associated with significantly longer ED and hospital stays, but not ICU admission rates.

Conclusions:

• Endoscopy performed after 24 hours is associated with increased hospital mortality in UGIH patients.
• Timely endoscopic intervention in UGIH may improve patient survival.
• Delayed endoscopy leads to prolonged healthcare resource utilization.