Endoscopic practice for upper gastrointestinal hemorrhage: differences between major teaching and community-based...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Healthcare Quality

Background:

• Endoscopic practices in major teaching versus community hospitals for upper gastrointestinal hemorrhage are not well-defined.
• Understanding these differences is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To compare endoscopic practice patterns and outcomes for upper gastrointestinal hemorrhage between major teaching and other hospitals.
• To identify variations in the utilization of endoscopic therapy and their association with patient outcomes.

Main Methods:

• A retrospective chart review of 1031 patients with upper gastrointestinal hemorrhage across 13 hospitals (4 major teaching, 9 others) in 1994.
• Multivariable analyses were employed to adjust for illness severity and endoscopic findings.

Main Results:

• Endoscopy rates were similar, but endoscopic hemostatic therapy was used more in major teaching hospitals (35% vs. 19%).
• Higher rates of endoscopic therapy were observed in teaching hospitals for recommended and other lesions.
• Recurrent bleeding was more frequent in major teaching hospitals (14.3% vs. 7.8%), persisting after multivariable adjustment (OR 1.69).
• Length of stay was slightly shorter in major teaching hospitals.

Conclusions:

• Significant variation exists in endoscopic therapy use, with higher rates in major teaching hospitals.
• Increased endoscopic therapy use in teaching hospitals may be linked to higher rebleeding rates.
• Further investigation is required to elucidate reasons for practice variation and its impact on readmissions and costs.