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

• Published in: Digestive diseases and sciences 2019-09, Vol.64 (9), p.2467-2477
• Main Authors: Akanbi, Olalekan, Adejumo, Adeyinka Charles
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; African Americans - statistics & numerical data; Aged; Biochemistry; Bowel disease; Clinical outcomes; Colitis, Ischemic - diagnostic imaging; Colitis, Ischemic - economics; Colitis, Ischemic - mortality; Colonoscopy; Colonoscopy - statistics & numerical data; Databases, Factual; Endoscopy; European Continental Ancestry Group - statistics & numerical data; Female; Gastroenterology; Hepatology; Hospital costs; Hospital Costs - statistics & numerical data; Hospital Mortality; Humans; Insurance, Health - statistics & numerical data; Intestinal ischemia; Length of Stay - statistics & numerical data; Male; Medicaid; Medicaid - statistics & numerical data; Medical care, Cost of; Medical research; Medicare - statistics & numerical data; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Oncology; Original Article; Patient outcomes; Retrospective Studies; Sigmoidoscopy - statistics & numerical data; Time Factors; Transplant Surgery; Treatment Outcome; United States - epidemiology; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05598-3

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.