The impact of endoscopy and specialist care on 30-day mortality among patients with acute non-variceal upper gastrointestinal hemorrhage: an Italian population-based study.
OBJECTIVE
To analyze the effects of endoscopy and care in a gastroenterology ward on 30-day mortality among Italian patients hospitalized for acute non-variceal upper gastrointestinal hemorrhage (UGIH).


METHODS
We conducted a population-based study based on administrative data contained in the Regional Hospital Information System (RHIS) for the Lazio Region (Italy). We identified all hospitalizations with a main diagnosis of UGIH during period 2000-2005. Discharge data were analyzed for procedures performed, ward where the patient was cared for, comorbidities, vital status at discharge. Vital status 30 days after admission was cross-checked with the Regional Registry of Causes of Death. Logistic regression models were performed taking into account patients' risk factors (OR and C.I. 95%).


RESULTS
A total of 13,427 hospitalizations for UGIH (mean patient age, 68 years; 60% males) were identified. The 30-day mortality was 6.9%. Significantly lower rates were observed among hospitalizations that included endoscopy (OR 0.30, 95% C.I. 0.26-0.34), specialist care (OR 0.55, 95% C.I. 0.37-0.82), or both (OR 0.12, 95% C.I. 0.07-0.22). The protective effects of endoscopy and specialist care remained strong after adjustment for potential risk factors.


CONCLUSIONS
Endoscopy, per se, reduces mortality among patients hospitalized for UGIH, and care in a gastroenterology ward may offer additional protective effects.
Kohn
Anna
A
Division of Gastroenterology AO San Camillo Forlanini, Circonvallazione gianicolense 87, 00152 Rome, Italy. akohn@scamilloforlanini.rm.it
Ancona
Carla
C
Belleudi
Valeria
V
Davoli
Marina
M
Giglio
Lucio
L
Fusco
Danilo
D
Andreoli
Arnaldo
A
Perucci
Carlo
C
Prantera
Cosimo
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020776:Endoscopes, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D007297:Inpatients; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D013038:Specialization; D014463:Ultrasonography; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*; D055815:Young Adult