Introduction: Lower gastrointestinal hemorrhage (LGIH) is one of the common reasons for hospitalization. In majority of the cases, bleeding stops spontaneously, however, older patients are at risk of high mortality and morbidity. Many diagnostic and therapeutic modalities are being utilized in the management of LGIH including upper gastrointestinal endoscopy, colonoscopy, CT angiogram (CTA), tagged RBC, laparoscopic and open surgeries. We aimed to evaluate the trends and utilization of these modalities in LGIH management.
Methods: All adult patients with a primary diagnosis and/or secondary diagnosis of LGIH were included in study using nationwide inpatient sample database from January 2016 to December 2019. Wilcoxon rank sum test was used for comparing continuous variables, Chi-square tests for categorical variables and linear regression to evaluate the trend over time. The primary outcome was to examine the utilization trend of imaging studies and procedures in patients admitted with LGIH.
Results: The sample size included 3,050,044 adult patients, of which 1,543,627(50.61%) were females. The mean age of patients was 70 ± 0.2 years. The utilization rates of upper gastrointestinal endoscopy and colonoscopy were the highest which has remained constant over the years. Similarly, the trend of CTA and nuclear scan use have been insignificant. The rate of arterial embolization has increased from 2% to 3.1% since 2016, p< 0.001. The rate of laparoscopic surgery increased from 1.19% to 1.31% (p=0.02) and that of open surgery increased from 3.84% to 4.5% (p< 0.001) from 2016 to 2019.
Discussion: This study illustrates a significant uptrend utilization of surgical modalities that indicates increasing rate of complex cases of LGIH and higher rate of complications requiring more invasive approach. Recent trend of increased utility of arterial embolization and its efficacy in the management of LGIH are promising. It may be used as alternative to more invasive surgical modalities.
