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

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Abstract

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.

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Abbreviations

EE:

Early endoscopy

LE:

Late endoscopy

NE:

No endoscopy

IB:

Ischemic bowel disease

IC:

Ischemic colitis

AKI:

Acute kidney injury

LOS:

Length of stay

THC:

Total hospital cost

TPN:

Total parenteral nutrition

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Author notes

  1. Olalekan Akanbi and Adeyinka Charles Adejumo contributed equally to the study concept, design, acquisition, analysis, interpretation of data, and drafting of the manuscript.

Authors and Affiliations

  1. Division of Hospital Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA

    Olalekan Akanbi

  2. Department of Medicine, North Shore Medical Center, Salem, MA, USA

    Adeyinka Charles Adejumo

  3. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Adeyinka Charles Adejumo

Authors
  1. Olalekan Akanbi
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  2. Adeyinka Charles Adejumo
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Correspondence to Olalekan Akanbi.

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Akanbi, O., Adejumo, A.C. Early Endoscopy Is Associated with Better Clinical Outcomes in Patients Hospitalized with Ischemic Bowel Disease. Dig Dis Sci 64, 2467–2477 (2019). https://doi.org/10.1007/s10620-019-05598-3

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  • DOI: https://doi.org/10.1007/s10620-019-05598-3

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