TBA (22W174)

BINGO – Bleeding In Ireland, The National Gastroenterology Outcome Study

Author(s)

Kumar L, McCrossan M, O'Morain N, Murray D, Byrne L, O'Sullivan G, Stewart S, Leyden J, O'Morain C, Doherty G

Department(s)/Institutions

1. St. Vincent's University Hospital 2. School of Medicine, University College Dublin 3. Mater Misericordiae University Hospital 4. HSE Acute Operations Endoscopy Programme 5. HSE Gastroenterology Clinical Programme, RCPI

Introduction

Gastrointestinal (GI) bleeding poses a significant burden on inpatient care and significant in-patient mortality. Previous audits have demonstrated variation in practice, with patchy adherence to guidelines. In Ireland, information regarding patient outcomes from GI bleeding is scarce.

Aims/Background

To follow the outcomes of patients admitted with gastrointestinal bleeding in Ireland, monitor trends in patient activity and to identify factors associated with adverse outcomes.

Method

Retrospective review of all acute admissions in Ireland between 2017 and 2022 with GI bleeding as the principal diagnosis was performed using NQAIS Clinical. Demographics such as age, gender, admission source was recorded and outcomes including mortality, readmission rates, and hospital length of stay (LOS) was analysed.

Results

Data from 16,456 emergency admissions was analysed. The median age was 70.5 years (IQR 53-81), 57.2% were male. Median LOS was 4 days (IQR 2-7). Overall mortality was 3.8% (n=625), 6.5% (n=1076) of admissions required high-dependency care and readmission rates within 7- and 30-days were 5% (n=818) and 12.2% (n=2013) respectively. Patient admissions were under a general medical team in 43.8%, a surgical team in 42.4% and gastroenterology in 12.9%. Weekend admissions (Friday-Sunday) were associated with an increased median LOS (4.0 days vs 3.0 days, p<0.001). Patients admitted under Gastroenterology had a longer average LOS (6.9 days vs 6.3 days, p<0.001) compared to other services but had an overall lower mortality (2.8% vs 3.9%, p=0.013). No significant difference was observed in admission rates, LOS, mortality, 7- and 30-day readmission during the COVID pandemic.

Conclusions

This is the first study to report national outcomes of patients admitted with GI bleeding and highlights variations which could be addressed by a GI bleeding care bundle. Patients with GI bleeding admitted at the weekend have a longer average LOS and suggest potential value of weekend endoscopy.