Timing of colonoscopy and outcomes in patients with lower GI bleeding: a nationwide population-based study

Abstract

Background: The role of urgent colonoscopy in lower GI bleeding (LGIB) remains controversial. Population-based studies on LGIB outcomes are lacking.

Objective: To investigate the impact of the timing of colonoscopy on outcomes of patients with LGIB.

Design: Cross-sectional study.

Setting: Nationwide Inpatient Sample 2010.

Patients: International Classification of Diseases, Ninth Revision, Clinical Modification codes identified patients with LGIB who underwent colonoscopy.

Main outcome measurements: In-hospital mortality, length of stay, and hospitalization costs in patients who underwent early (≤24 hours) or delayed (>24 hours) colonoscopy.

Results: A total of 58,296 discharges with LGIB were identified; 22,720 had a colonoscopy performed during the hospitalization. A total of 9156 patients had colonoscopy performed within 24 hours (early colonoscopy), and 13,564 had colonoscopy performed after 24 hours (delayed colonoscopy). There was no difference in mortality in patients with LGIB who had early versus delayed colonoscopy (0.3% vs 0.4%, P = .24). However, patients who underwent early colonoscopy had a shorter length of hospital stay (2.9 vs 4.6 days, P < .001), decreased need for blood transfusion (44.6% vs 53.8%, P < .001), and lower hospitalization costs ($22,142 vs $28,749, P < .001). On multivariate analysis, timing of colonoscopy did not affect mortality (adjusted odds ratio 1.5; 95% confidence interval, 0.7-2.7). On multivariate analysis, delayed colonoscopy was associated with an increase in the length of hospital stay by 1.6 days and an increase in hospitalization costs of $7187.

Limitations: Administrative dataset.

Conclusions: Early colonoscopy within 24 hours is associated with decreased length of hospital stay and hospitalization costs in patients with LGIB.

Keywords: CCI; CI; Charlson Comorbidity Index; HCUP; Healthcare Cost and Utilization Project; ICD-9-CM; International Classification of Diseases, Ninth Revision, Clinical Modification; LGIB; LOS; NIS; Nationwide Inpatient Sample; RCT; aOR; adjusted odds ratio; confidence interval; length of stay; lower GI bleeding; randomized, controlled trial.