P4177 - It Is Not Who You Are, It Is Where You Are: The Urban-Rural Divide in Non-Variceal Upper Gastrointestinal Bleeding Treatment Outcomes

Dipam Shah, MD¹, Reem Q.. Al Shabeeb, MD², Kathryn Hobbs, MD¹, Marwan Abougergi, MD^3
1Inova Fairfax Medical Campus, Fairfax, VA; ²Inova Fairfax Medical Campus, Silver Spring, MD; ³Inova Health System, Falls Church, PA

Introduction: Non-variceal upper gastrointestinal hemorrhage (NVUGIH) is the most common gastrointestinal emergency. To our knowledge, no large-scale study has explored the relationship between patient location (urban versus rural) and NVUGIH treatment outcomes. We aimed to address this important question

Methods: This retrospective cohort study used the National Inpatient Sample 2021. Admissions with a principal diagnosis of NVUGIH were included. Patients under 18 years and elective admissions were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were 1-treatment modalities: upper endoscopy (EGD), endoscopic, radiologic and surgical therapy, 2-morbidity: hypovolemic shock and mechanical ventilation for >24 hours (PMV), 3- resource utilization: length of stay (LOS), total hospitalization costs and charges. Multivariate regression was used to adjust for the confounders in Table 1

Results: The study included 243,080 patients: 52% from large metropolitan ( > 1 million population), 32% from medium metropolitan (50,000 to 1 million population) and 16% from rural areas. The in-hospital mortality rate was 1.8%. The rates of in-hospital and early EGD were 88% and 55%, respectively. The rates of endoscopic, radiologic and surgical therapy were 30%, 1%, and 0.03%, respectively. The rates of hypovolemic shock and PMV were 3% and 2.4%. The mean LOS was 4.7 days. The mean total hospitalization costs and charges were $14,661 and $63,060, respectively

Compared with patients from large and medium urban areas, patients from rural areas were less likely to be treated at teaching hospitals (80%, 74%, 47%, p< 0.01) and more likely to be transfers from other hospitals (4%, 6%, 24%, p< 0.01). Adjusted results are presented in Table 1. Patients from rural areas had significantly higher odds of in-hospital mortality. This difference persisted when the analysis was restricted to urban teaching hospitals. Patients from rural areas also had higher odds of early EGD, endoscopic and radiologic therapy as well as shock. Despite similar LOS and hospitalization costs, patients from rural areas had lower hospitalization charges

Discussion: Among patients with NVUGIH, those living in rural areas experience higher in-hospital mortality and morbidity but lower resource utilization. We found differences in patient acuity and the availability of endoscopic, radiologic and/or surgical treatments which may explain this disparity. Further research is needed to validate and further clarify the present findings


Disclosures:


Dipam Shah, MD¹, Reem Q.. Al Shabeeb, MD², Kathryn Hobbs, MD¹, Marwan Abougergi, MD³. P4177 - It Is Not Who You Are, It Is Where You Are: The Urban-Rural Divide in Non-Variceal Upper Gastrointestinal Bleeding Treatment Outcomes, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.