P0450 - Post-Bariatric Surgery Complicated With Upper Gastrointestinal Bleed - Inpatient Mortality and Temporal Associations

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Umesh Bhagat, MD

Saint Peter's University Hospital
New Brunswick, NJ, United States

Umesh Bhagat, MD, Luisa Recinos, MD, Christian Toquica, MD
Saint Peter's University Hospital, New Brunswick, NJ

Introduction: Bariatric surgeries (BS) has been associated with Upper Gastrointestinal Bleed (UGIB) in the past. Studies identifying the mortality risk factors among the population with history of BS and being admitted with UGIB are lacking. In this study, we attempt to identify risk factors related to inpatient mortality of patients with history of BS being admitted with UGIB.

Methods: We queried the NIS database 2018 using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the patients with a primary diagnosis of UGIB and post-bariatric surgery status. The primary outcome was mortality. Analysis was performed with STATA software. T test was used for continues variables and chi square test was used for categorical variable. Logistic as well as multivariate regression was used to identify risk factors

Results: 254,725 patients met the inclusion criteria,11,208 were admitted with UGIB. The mean age was 56.4 for the patients with bleeding and 55.2 for those without. Patients with UGIB had shorter duration of stay than without UGIB (3.7 vs 4.6). The mean time to upper endoscopy was 1.97 days. On descriptive analysis female sex, obesity, history of heart failure, and diabetes mellitus were all found to have a significant negative relationship in the target patients, coincidently history of CAD was found to have a significant positive relationship. On logistic regression analysis female sex (OR 0.75, p < 0.001); Obesity (OR 0.61 p < 0.001); and inpatient EGD (OR 0.83 p 0.001) had significantly lower likelihood of mortality. History of comorbidities like HF and coronary artery disease (CAD) had increased likelihood of mortality with OR 1.8 (< 0.001) and 1.41 (p< 0.001) respectively. History of hypertension and diabetes mellitus had no significant association with mortality. When adjusting for cofounders the aOR were similar for: female sex, obesity, inpatient EGD, HF, and CAD. On the contrary, the variables DM and HTN were found to significantly decreased the likelihood of mortality with OR 0.89 (p 0.016) and 0.86 (p < 0.001) respectively.

Discussion: The patients with preexisting heart failure and coronary artery disease had increased mortality on the contrary, the patients with obesity, female sex and those that underwent inpatient EGD had decrease in mortality. Interestingly obese patients had decrease in mortality. On the other hand, optimization of their preexisting cardiac conditions can greatly improve outcomes and reduce mortality.

	Mortality in post-bariatric surgery patients that had UGIB (OR)
	uOR	95% CI	P Value	aOR	95%CI	P Value
Female	0.75	0.70-0.82	< 0.001	0.79	0.73-0.86	< 0.001
Obesity	0.61	0.54-0.68	< 0.001	0.61	0.54-0.68	< 0.001
CHF	1.8	1.68-2.00	< 0.001	1.88	1.70-2.07	< 0.001
CAD	1.41	1.30-1.53	< 0.001	1.18	1.07-1.30	0.001
EGD	0.83	0.75-0.92	0.001	0.76	0.69-0.84	< 0.001
HTN	1.005	0.92-1.09	0.89	0.86	0.78-0.94	< 0.001
Smoking	0.93	0.72-1.19	0.59	0.92	0.71-1.18	0.518
DM	0.94	0.87-1.03	0.24	0.89	0.81-0.98	0.016
	Reference category: Female, No obesity, No CHF, No CAD, No DM, No EGD, No HTN, No smoking, No DM

Disclosures:

Umesh Bhagat indicated no relevant financial relationships.

Luisa Recinos indicated no relevant financial relationships.

Christian Toquica indicated no relevant financial relationships.

Umesh Bhagat, MD, Luisa Recinos, MD, Christian Toquica, MD. P0450 - Post-Bariatric Surgery Complicated With Upper Gastrointestinal Bleed - Inpatient Mortality and Temporal Associations, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.