P2390 - Outcomes and Complications in Patients With Stimulant Abuse, Admitted for NVUGIB: A 2016-2020 United States National Analysis

Khaled Al Smadi, MD¹, Miguel J. Salazar, MD², Pedro Palacios, MD³, Do Han Kim, MD⁴, Ko Dong, MD⁵, Gianina Flocco, MD⁶, George Saffouri, MD⁷, Harold Paredes, MD^7
1University of California Riverside School of Medicine, San Bernardino, CA; ²University of California Riverside, Rancho Cucamonga, CA; ³Mayo Clinic, Jacksonville, FL; ⁴Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY; ⁵Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT; ⁶Cleveland Clinic, Cleveland, OH; ⁷University of California Riverside, Rialto, CA

Introduction: Nonvariceal upper gastrointestinal bleed (NVUGI) carries high mortality and morbidity. Stimulant abuse (SA) is a growing epidemic with well established increases in age adjusted mortality. SA has been reported as a potential cause of serious GI complications, and outcomes in anesthesia have demonstrated higher risk for adverse events including mortality. Accordingly, we aim to investigate the effect stimulant use in NVUGI and consequences during hospitalization.

Methods: In this study we recruited patients from the National Inpatient Sample for the years 2016-2020. Using the ICD10-PCS codes, we recognized patients discharged after admission for NVUGI then divided them into two groups based on the presence or absence of SA. The primary end point was in-hospital mortality while secondary end points were in-hospital systemic complications, length of stay (LOS) and healthcare related charges and costs. Multivariate logistic regression analysis was conducted to adjust for confounders.

Results: A total of 1,984,524 patients with discharges after NVUGI were identified out of which 12,029 (0.6%) had associated SA. Mallory Weiss tear was the most likely cause of GI bleed (6.4% vs.3.2%; p< 0.01), also higher rates of esophageal, gastric and duodenal ulcers (9.9%vs.4.5%, 16.2%vs. 4.3%, 13.9%vs.11.2%; p< 0.01). They were less likely females (30.1%vs.46.9%; p< 0.01) and more likely younger (mean age 49.1vs.67.5; p< 0.01), with predominant White race in both groups (58.9%vs.67.5%; p< 0.01) and more Hispanics among SA group (19.9%vs.9.1%; p< 0.01). SA had higher rates of OH abuse (42.9%vs.12.6%, p< 0,01), cannabis abuse (20.9%vs.1.7%; p< 0.01), opiate abuse (13.9%vs.1.4%; p< 0.01) and tobacco abuse (2.7%vs.0.9%; p< 0.01). After adjusting for confounders patients with SA they had higher odds for SIRS (1.57, CI 1.21–2.02; p< 0.01), AKI (1.63, CI 1.32–2.03; p< 0.01), hemodialysis (0.29, CI 0.13–0.65; p< 0.01), endotracheal intubation (1.55, CI 1.28–1.88; p< 0.01) and need for IR-embolization (2.17, CI 1.15–4.09; p< 0.01). They did not have increased risk for mortality (0.51, CI 0.18–1.35; p=0.17), prolonged LOS or delay in EGD (-0.01, CI -0.28–0.77; p=0.26) but had higher hospital charges CI 12,320, CI 5,224–19,415; p< 0.01).

Discussion: Although patients with SA did not have higher odds for in-hospital mortality, they had higher odds for in-hospital systemic complications. Efforts to target substance abuse should be implemented when these patients are admitted to the hospital.


Disclosures:


Khaled Al Smadi, MD¹, Miguel J. Salazar, MD², Pedro Palacios, MD³, Do Han Kim, MD⁴, Ko Dong, MD⁵, Gianina Flocco, MD⁶, George Saffouri, MD⁷, Harold Paredes, MD⁷. P2390 - Outcomes and Complications in Patients With Stimulant Abuse, Admitted for NVUGIB: A 2016-2020 United States National Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.