D0311 - Diagnostic and Therapeutic Interventions in Acute Variceal Bleeding: Trends, Mortality, and Outcomes Comparison by Timing of Procedures, NIS 2004-2019

Sharanya Reddy Nemakallu, MD¹, Ese Uwagbale, MD², Aaron Sircy, MD³, Aftaab Aliahmad, MD⁴, Swathi Rajagopal, MD⁴, Kelechi C. Meremikwu, MD⁴, Junxin Shi, MD, PhD⁵, Glory Emasoga, MD⁶, Giorgi Derevenskikh, MD⁶, Navina Mohan, MD⁷, Benjamin Silver, MD⁸, Tamta Chkhikvadze, MD^9
1One Brooklyn Health Interfaith Medical Center, Brooklyn, NY; ²Rochester General Hospital, Rochester, NY; ³Saba University School of Medicine, Devens, MA; ⁴One Brooklyn Health System, Brooklyn, NY; ⁵The Research Institute at Nationwide Children's Hospital, Columbus, OH; ⁶One Brooklyn Health System Brookdale University Hospital, Brooklyn, NY; ⁷NYU Langone Hospital Brooklyn, Brooklyn, NY; ⁸SUNY Downstate Health Sciences University, Brooklyn, NY; ⁹NYU Grossman School of Medicine, Brooklyn, NY

Introduction: Acute variceal bleeding (AVB) is a life-threatening emergency with a high mortality rate. Management requires endoscopic intervention after fluid resuscitation, ideally within 12 hours of presentation. We aimed to analyze AVB hospitalizations, the timing of procedures, and outcomes such as mortality and hospital resource utilization.

Methods: We extracted adult hospitalizations from Nationwide Inpatient Sample (NIS) 2004-2019yy with ICD-9 and ICD-10 Diagnosis codes of AVB (456.0,I85.01) and associated procedure codes of esophagoscopy (EGD) and esophageal variceal ligation (EVL) (42.22,42.23,42.33,42.91,44.43,45.13, 49.95,0DJ08ZZ,0W3P8ZZ,06L38CZ,06L34CZ). We divided procedure timing into early (< 24hrs) and delayed ( >24hrs). Mortality, length of stay (LOS), and mean charges (MC) were used as outcomes. These outcomes were compared between early and delayed procedure groups.

Results: Over a 16-year period, AVB hospitalizations increased from 4,798 in 2004 to 8,095 in 2019, with a peak of 9,280 in 2016. Timing of procedures has not shown significant change, ranging from 76% to 80% of EGDs performed in < 24 hours across all years. There was significant male-to-female predominance (69% vs. 31% in 2004; 63% vs. 37% in 2019). The racial distribution was similar over time, except for a minor increase in Native American/Other and Asian or Pacific Islander hospitalizations and a decrease in Black patient hospitalizations. A large shift was noted in hospitalizations towards teaching institutions (39% in 2004 to 74% in 2019). Mortality of early and delayed procedure groups is demonstrated in Figure 1. Overall mortality was 6.4% (95% CI:6.02%-6.83%) in the early and 9.1% (95% CI: 8.18%-10.01%) in the delayed procedure group. MC has increased, by +Δ $62,527.00 for early and +Δ $105,406.00 for the delayed procedure group; Mean LOS was 5 (95% CI 5.0-5.1) and 9 days (95% CI 8.8-9.4) for early and delayed groups, respectively.

Discussion: From 2004 to 2019, hospitalizations for acute variceal bleeding, as well as associated therapeutic procedures, costs, and lengths of stay have steadily increased. There was a notable spike in hospitalizations in 2016, however, this coincided with ICD coding transition. Most EGD and EVL procedures (76-80%) were performed in < 24 hours from admission. Inpatient mortality is notably higher if interventions for AVB are delayed. Early and timely interventions should be strongly encouraged and performed.



Disclosures:


Sharanya Reddy Nemakallu, MD¹, Ese Uwagbale, MD², Aaron Sircy, MD³, Aftaab Aliahmad, MD⁴, Swathi Rajagopal, MD⁴, Kelechi C. Meremikwu, MD⁴, Junxin Shi, MD, PhD⁵, Glory Emasoga, MD⁶, Giorgi Derevenskikh, MD⁶, Navina Mohan, MD⁷, Benjamin Silver, MD⁸, Tamta Chkhikvadze, MD⁹. D0311 - Diagnostic and Therapeutic Interventions in Acute Variceal Bleeding: Trends, Mortality, and Outcomes Comparison by Timing of Procedures, NIS 2004-2019, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.