E0301 - Characteristics and Outcomes of Geriatrics Patients Admitted for Upper Gastrointestinal Bleeding: A Population-Based Age-Stratified Retrospective Study

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Mohammad Aldiabat, MBBS

NYU Langone Hospital - Long Island
New York, NY

Mohammad Aldiabat, MBBS¹, Yazan Aljabiri, MBBS², Fnu Farukhuddin, MD³, Mubarak Yusuf, MD³, Yassine Kilani, MD², Ali Horoub, MD³, Odai Alkhdour, MD⁴, Sura Issa, MD⁵
¹NYU Langone Hospital - Long Island, New York, NY; ²NYCHHC/Lincoln Medical Center, Bronx, NY; ³NYCHHC/Lincoln Medical Center, New York, NY; ⁴Yarmouk University, Irbid, Irbid, Jordan; ⁵The University of Jordan, New York, NY

Introduction: Advanced age is a well-known risk factor for mortality in Upper Gastrointestinal Bleeding (UGIB). However, the characteristics and outcomes of elderly patients hospitalized for UGIB remains understudied.

Methods: Using ICD-10 codes, the National Inpatient Sample database of the years 2016 to 2019 was searched for to geriatric (≥ 65 years old) and non-geriatric (18-65 years old) patients who were admitted with a primary diagnosis of UGIB. Multivariate logistic regression analysis was performed to determine the risk of mortality and in-hospital complications in geriatric patient admitted for UGIB compared to their younger counterparts. Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was < 0.05.

Results: Among 1,656,594 adults’ patients who were hospitalized in US with a primary diagnosis of UGIB from 2016 - 2019, 1,022,295 (61.7%) were ≥ 65 years old. Age-stratified patients baseline characteristics are listed in Table 1. Geriatric patients have a 1.7-fold increase in risk of UGIB (OR 1.74, p< 0.001) with 1.9-fold increase in risk of mortality (OR 1.91, p< 0.001). In term of in-hospital outcomes (Figure 1), Geriatric patients had a higher risk of septic shock (OR 1.26, p< 0.001), acute kidney injury (OR 1.59, p< 0.001), acute coronary syndrome (OR 1.37, p< 0.001), in-hospital cardiac arrest (OR 1.65, p< 0.001), hypovolemic shock (OR 1.11, p< 0.001), UTIs (OR 1.89, p< 0.001), pneumonia (OR 1.36, p< 0.001), malnutrition (OR 1.41, p< 0.001) and acute respiratory failure (OR 1.22, p< 0.001) when comparted to non-geriatric patients. Interestingly, geriatric/UGIB patients had no significant difference in length of stay (Coefficient 0.28 days, p< 0.001) and cost of care (Coefficient -750$, p< 0.001) when compared to younger subjects.

Discussion: Geriatric population suffering UGIB have higher rates of mortality, septic shock, acute kidney injury, acute coronary syndrome, in-hospital cardiac arrest, hypovolemic shock, UTIs, pneumonia and acute respiratory failure with similar healthcare resources utilization to younger subjects. These results are likely related to the higher comorbidities and the benefits/risk balance of undergoing invasive therapeutic measures in this friable age group. This necessitates proper risk stratification, treatment protocols and early identification of goals of care for geriatric patients admitted for UGIB.

Figure: Forest plot of outcomes of geriatric patients hospitalized for UGIB compared to non-geriatric patients.

Variable	Overall UGIB %, No.	NON-GERIATRICS %, No.	GERIATRICS %, No.	P value
	100.0 (1,656,594)	38.2% (634299)	61.7 (1,022,295)
Patient’s characteristics
Age, mean years	67.6	51.0	77.9 (796368)	< 0.001
Female	46.7 (773629)	38.8 (246108)	51.6 (527504)	< 0.001
Racial distribution
White	69.4 (1149676)	60.1 (381214)	75.1 (767744)
Black	14.7 (243519)	19.1 (121151)	12.0 (122675)
Hispanic	9.47 (156879)	13.2 (83727)	7.14 (72992)
Others	2.40 (39758)	2.97 (18839)	2.05 (20957)
Insurance type				< 0.001
Medicaid	66.3 (1098322)	24.2 (153500)	91.6 (936422)
Medicare	12.1 (200448)	29.9 (189655)	1.43 (14619)
Private	17.2 (284934)	35.2 (223273)	6.39 (65325)
Uninsured	4.27 (70737)	10.5 (66601)	0.52 (5316)
Charlson comorbidity index score				< 0.001
1	21.9 (362794)	26.9 (170626)	18.9 (193214)
2	17.3 (286591)	15.3 (97048)	18.5 (189125)
≥3	49.0 (811731)	41.1 (260697)	53.9 (551017)
Median annual income, us$				< 0.001
1–43,999	31.1 (515201)	35.3 (223908)	28.5 (291354)
44,000–55,999	26.5 (438997)	26.3 (166821)	26.6 (271930)
56,000–73,999	23.5 (389300)	22.2 (140814)	24.4 (249440)
≥74,000	18.7 (309783)	15.9 (100854)	20.4 (208548)
Hospital characteristics
Hospital region				< 0.001
Northeast	18.0 (298187)	15.7 (99585)	19.5 (199348)
Midwest	22.1 (366107)	20.5 (130031)	23.0 (235128)
South	39.8 (659324)	41.3 (261965)	38.8 (396650)
West	20.0 (331319)	22.3 (141449)	18.5 (189125)
Hospital bed size				< 0.001
Small	20.3 (336289)	19.2 (121785)	20.9 (213660)
Medium	30.7 (508574)	30.2 (191558)	31.0 (316911)
Large	48.9 (810074)	50.5 (320321)	47.9 (489679)
Hospital location
Rural location	9.10 (150750)	7.53 (47763)	10.1 (103252)	< 0.001
Urban location	23.9 (395926)	22.8 (144620)	24.7 (252507)
Teaching hospital	66.8 (1106605)	69.6 (441472)	65.1 (665514)
Comorbidities
Hypertension	39.2 (649385)	35.8 (227079)	41.3 (422208)	< 0.001
Hyperlipidemia	40.1 (664294)	23.5 (149060)	50.4 (515237)	< 0.001
Smoking history	40.4 (669264)	45.9 (291143)	37.0 (378249)	< 0.001
Diabetes mellitus	32.1 (531767)	25.9 (164283)	35.9 (367004)	< 0.001
Congestive heart failure	21.8 (361137)	10.7 (67870)	28.7 (293399)	< 0.001
Atrial fibrillation	17.5 (289904)	6.12 (38819)	24.6 (251485)	< 0.001
Atrial flutter	1.43 (23689)	0.68 (4313)	1.91 (19526)	< 0.001
Coronary artery disease	29.8 (493665)	14.9 (94511)	39.0 (398695)	< 0.001
Carotid artery disease	1.10 (18223)	0.36 (2283)	1.57 (16050)	< 0.001
Peripheral vascular disease	4.80 (79517)	2.16 (13701)	6.44 (65836)	< 0.001
Chronic obstructive lung disease	18.5 (306470)	12.4 (78653)	22.5 (230016)	< 0.001
Chronic kidney disease	26.2 (434028)	15.6 (98951)	32.9 (336335)	< 0.001
Obesity	12.6 (208731)	14.9 (94511)	11.2 (114497)	< 0.001
Chronic liver disease	15.8 (261742)	27.0 (171261)	8.86 (90575)	< 0.001
Peptic ulcer disease	12.6 (208731)	13.4 (84996)	12.1 (123698)	< 0.001
Hiatal hernia	21.5 (356168)	17.7 (112271)	24.0 (245351)	< 0.001
Portal hypertension	6.58 (109004)	11.9 (75482)	3.25 (33225)	< 0.001
Gastroesophageal reflux disease	27.9 (462190)	26.7 (169358)	28.7 (293399)
Alcohol use	13.1 (217014)	26.8 (169992)	4.75 (48559)	< 0.001
Esophageal varices	4.81 (79682)	8.58 (54423)	2.48 (25353)	< 0.001

Table: Baseline characteristics and comorbidities of study sample stratified according to patients age group (UGIB=Upper Gastrointestinal Bleeding).

Disclosures:

Mohammad Aldiabat indicated no relevant financial relationships.

Yazan Aljabiri indicated no relevant financial relationships.

Fnu Farukhuddin indicated no relevant financial relationships.

Mubarak Yusuf indicated no relevant financial relationships.

Yassine Kilani indicated no relevant financial relationships.

Ali Horoub indicated no relevant financial relationships.

Odai Alkhdour indicated no relevant financial relationships.

Sura Issa indicated no relevant financial relationships.

Mohammad Aldiabat, MBBS¹, Yazan Aljabiri, MBBS², Fnu Farukhuddin, MD³, Mubarak Yusuf, MD³, Yassine Kilani, MD², Ali Horoub, MD³, Odai Alkhdour, MD⁴, Sura Issa, MD⁵. E0301 - Characteristics and Outcomes of Geriatrics Patients Admitted for Upper Gastrointestinal Bleeding: A Population-Based Age-Stratified Retrospective Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.