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Emergency readmission following acute upper gastrointestinal bleeding

Strömdahl, Martin; Helgeson, Johan and Kalaitzakis, Evangelos LU (2017) In European Journal of Gastroenterology and Hepatology 29(1). p.73-77
Abstract

OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009–2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated. RESULTS: A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions... (More)

OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009–2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated. RESULTS: A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital mortality did not differ significantly between index admissions and readmissions (13.7 vs. 9.8%, P=0.181). In logistic regression analysis, only a higher Charlson comorbidity index [odds ratio (OR): 1.154, 95% confidence interval (CI): 1.056–1.261] was related to emergency readmission. Bisphosphonate use (OR: 3.933, 95% CI: 1.264–12.233), previous AUGIB (OR: 2.407, 95% CI: 1.157–5.009), and length of stay at index admission (>5 days; OR: 0.246, 95% CI: 0.093–0.649) were found to be independent predictors of postdischarge rebleeding. CONCLUSION: All-cause emergency readmission following AUGIB is frequent. It is related to rebleeding in one-fifth of cases and mortality is similar to that in index admissions. The presence of comorbid illness appears to predict readmissions. Reduced length of stay and bisphosphonate use appear to be important, potentially modifiable, predictors of postdischarge rebleeding.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Gastroenterology and Hepatology
volume
29
issue
1
pages
73 - 77
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:84991515506
  • wos:000390250600013
ISSN
0954-691X
DOI
10.1097/MEG.0000000000000746
language
English
LU publication?
yes
id
435cbf4f-e308-4fe9-839d-07c576915f99
date added to LUP
2016-11-18 10:32:16
date last changed
2018-03-18 05:06:16
@article{435cbf4f-e308-4fe9-839d-07c576915f99,
  abstract     = {<p>OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009–2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated. RESULTS: A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital mortality did not differ significantly between index admissions and readmissions (13.7 vs. 9.8%, P=0.181). In logistic regression analysis, only a higher Charlson comorbidity index [odds ratio (OR): 1.154, 95% confidence interval (CI): 1.056–1.261] was related to emergency readmission. Bisphosphonate use (OR: 3.933, 95% CI: 1.264–12.233), previous AUGIB (OR: 2.407, 95% CI: 1.157–5.009), and length of stay at index admission (&gt;5 days; OR: 0.246, 95% CI: 0.093–0.649) were found to be independent predictors of postdischarge rebleeding. CONCLUSION: All-cause emergency readmission following AUGIB is frequent. It is related to rebleeding in one-fifth of cases and mortality is similar to that in index admissions. The presence of comorbid illness appears to predict readmissions. Reduced length of stay and bisphosphonate use appear to be important, potentially modifiable, predictors of postdischarge rebleeding.</p>},
  author       = {Strömdahl, Martin and Helgeson, Johan and Kalaitzakis, Evangelos},
  issn         = {0954-691X},
  language     = {eng},
  number       = {1},
  pages        = {73--77},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {European Journal of Gastroenterology and Hepatology},
  title        = {Emergency readmission following acute upper gastrointestinal bleeding},
  url          = {http://dx.doi.org/10.1097/MEG.0000000000000746},
  volume       = {29},
  year         = {2017},
}