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


METHODS
Cross-sectional study.


METHODS
Nationwide Inpatient Sample 2010.


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


METHODS
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.


CONCLUSIONS
Administrative dataset.


CONCLUSIONS
Early colonoscopy within 24 hours is associated with decreased length of hospital stay and hospitalization costs in patients with LGIB.
Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio.
Udayakumar
U
Navaneethan
Department of Medicine, University of Connecticut Medical Center, Farmington, Connecticut.
Basile
B
Njei
Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio.
Preethi G K
PG
Venkatesh
Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio.
Madhusudhan R
MR
Sanaka
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D061646:Operative Time; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
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