title: The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis.
abstract: BACKGROUND
  Despite major advances in upper GI hemorrhage (UGIH) treatment, UGIH mortality has been reported as unchanged for the past 50 years.
  
  
  OBJECTIVE
  To measure the UGIH in-hospital mortality rate and other important outcome trends from 1989 to 2009.
  
  
  METHODS
  A longitudinal study of UGIH hospitalizations by using the Nationwide Inpatient Sample.
  
  
  METHODS
  Acute-care hospitals.
  
  
  METHODS
  All patients admitted for UGIH. Patients who bled after admission were excluded.
  
  
  METHODS
  UGIH in-hospital mortality rate, incidence, in-hospital endoscopy and endoscopic therapy rates, length of hospital stay, and total in-hospital charges.
  
  
  RESULTS
  The non-variceal UGIH mortality rate decreased from 4.5% in 1989 to 2.1% in 2009. The non-variceal UGIH incidence declined from 108 to 78 cases/100,000 persons in 1994 and 2009, respectively. In-hospital upper endoscopy and endoscopic therapy rates increased from 70% and 10% in 1989 to 85% and 27% in 2009, respectively. The early endoscopy rate increased from 36% in 1989 to 54% in 2009. The median length of hospital stay decreased from 4.5 days in 1989 to 2.8 days in 2009. Median total hospitalization charges increased from $9249 in 1989 to $20,370 in 2009. At the national level, the UGIH direct in-hospital economic burden increased from $3.3 billion in 1989 to $7.6 billion in 2009. Similar trends were found for variceal UGIH.
  
  
  CONCLUSIONS
  Retrospective data, administrative database.
  
  
  CONCLUSIONS
  In-hospital mortality from UGIH has been decreasing over the past 2 decades, with a concomitant increase in rate of endoscopy and endoscopic therapy. However, despite decreasing length of stay, the total economic burden of UGIH is increasing.
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Marwan S
authors.initials: MS
authors.lastname: Abougergi
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Travis
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Saltzman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D016099:Endoscopy, Gastrointestinal / Q000639:trends; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000191:economics / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000639:trends*; D017722:Hospital Charges / Q000639:trends; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology