The Impact of Obesity on Mortality and Other Outcomes in Patients With Nonvariceal Upper Gastrointestinal Hemorrhage in the United States

OBJECTIVES: Acute nonvariceal upper gastrointestinal hemorrhage (UGIH) remains a common indication for hospital admission. Differences in the structure, process and outcomes of care in the management of acute nonvariceal UGIH between providers in Canada and the United States have not been previously characterized. The aim of the present study was to compare the structure, process and outcomes of care between a Canadian and an American tertiary care medical centre in the management of acute nonvariceal UGIH.METHODS: Data were collected from identified cases of acute non-variceal UGIH at the two medical centres over two years. Process measures analyzed included the level of care (intensive care unit [ICU] monitored bed versus unmonitored bed) and hospital length of stay (HLOS). Outcomes assessed included rebleeding, inhospital mortality and readmission and/or death within 30 days of admission.RESULTS: One hundred seventy-five and 83 cases of acute non-variceal UGIH were identified at the American and Canadian centres, respectively. Cases at the American centre had a lower median HLOS, (2.6 versus 3.9 days, P<0.001) but were significantly more likely to be treated in an ICU or monitored setting (67% versus 16%, P<0.001). There were no significant differences in rates of rebleeding or death in hospital or within 30 days of discharge.CONCLUSIONS: Marked differences exist in the process of care between the Canadian and American medical centres in the management of acute nonvariceal UGIH, despite similar patient severity. Outcomes between the two centres were similar. Minimizing disparity in the process of care of acute UGIH between the two centres may reduce excessive use of resources in the management of acute UGIH without promoting adverse outcomes.

Download Full-text

Clinical and endoscopic aspects in the evolution of patients with bleeding peptic ulcer: a cohort study

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032000000300005 ◽

2000 ◽

Vol 37 (3) ◽

pp. 162-167 ◽

Cited By ~ 3

Author(s):

Fábio SEGAL ◽

João Carlos PROLLA ◽

Ismael MAGUILNIK ◽

Fernando H. WOLFF

Keyword(s):

Peptic Ulcer ◽

Cohort Study ◽

Gastrointestinal Hemorrhage ◽

Clinical History ◽

The United States ◽

Bleeding Peptic Ulcer ◽

Upper Gastrointestinal Hemorrhage ◽

Risk Of Death ◽

Bleeding Ulcers ◽

Upper Gastrointestinal

Background - Bleeding ulcers are a major problem in public health and represent approximately half of all the cases of upper gastrointestinal hemorrhage in the United States. This study aims to determine the prognostic value of factors such as clinical history, laboratory and endoscopic findings in the occurrence of new episodes of bleeding in patients who have upper gastrointestinal hemorrhage caused by gastric or duodenal peptic ulcer. Methods - A cohort study with 94 patients was designed to investigate prognostic factors to the occurrence of new episodes of bleeding. Results - From the 94 patients studied, 88 did not present a new bleeding episode in the 7 days following hospital admission. The incidence of rebleeding was significantly higher in those patients with hemoglobin <6 g/dL at the admission (P = 0.03, RR = 6.2). The localization of the ulcers in bulb was positively associated to rebleeding (P = 0.003).The rebleeding group needed a greater number of units transfunded (P = 0.03) and the time of hospitalization was longer than the time of the hemostasia group (P = 0.0349). Conclusions - The identification of patients with risk of death by bleeding peptic ulcer remains as a challenge, once few factors are capable of predicting the severity of the evolution. The identification of such factors will allow the choice of the better therapeutic conduct improving the diagnosis and decreasing the rate of rebleeding and the mortality.

Download Full-text