P4159 - Healthcare Utilization, Risk Factors, and 30-Day Readmission of Patients With Non-Variceal Upper Gastrointestinal Bleeding in Prosthetic Cardiac Valves on Anticoagulation

Shahryar Khan, MD¹, Yousaf Zafar, MD², Mashal Alam Khan, MBBS³, Hoor Umar Afridi, MBBS⁴, Ahmad Khan, MBBS⁵, Aamer Ahmad, MBBS⁶, Rizwan Afridi, ^7
1University of Kansas, Overland Park, KS; ²University of Mississippi Medical Center, Madison, MS; ³Khyber Medical University, Overland Park, KS; ⁴Khyber Girls Medical College, Peshawar, North-West Frontier, Pakistan; ⁵Khyber Teaching Hospital, Nowshera, North-West Frontier, Pakistan; ⁶Khyber Medical University, Peshawar, North-West Frontier, Pakistan; ⁷Khyber Medical College, Peshawar, North-West Frontier, Pakistan

Introduction: Several patients undergo prosthetic valve replacements (PVR) in valvular heart disease. There are two types of valve prosthesis including mechanical and bioprosthetic valves. Patients with mechanical valves are treated with systemic anticoagulation (AC) to prevent valve thrombosis. It is complicated with major bleeding episodes such as intracranial hemorrhage or gastrointestinal bleeding, and holding anticoagulation can be challenging due to high risk of thromboembolic events. We aimed to investigate healthcare utilization, the rate of hospital readmissions, and outcomes for 30-days readmission of patients admitted with Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB) in this patient population.

Methods: We retrospectively analyzed the Nationwide Readmission Database from 2018 to 2020 to identify patients hospitalized with NVUGIB in PVR on AC (PVR-AC). Discharges were included if they were adults, urgent/emergent and had a principal ICD-10 CM code indicating NVUGIB, PVR, and AC. A readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. Same day admissions and discharges were excluded. The primary outcome was 30-day readmission, causes of readmissions, and resource utilization. Independent risk factors for readmission were identified using multivariate cox regression analysis.

Results: The number of patients admitted with NVUGIB in PVR-AC was 8,759. The mean age was 71.87 years and 44.9% of patients were female. Out of these, 3.8% of patients got readmitted within the next 30 days. Figure 1 shows the Kaplan-Meier curve for 30-Day readmission. The most common 5 principal diagnoses for readmissions were angiodysplasia (33.5%), gastric ulcer (21%), duodenal ulcer (12.5%), dieulafoy lesion (7.5%), and gastritis (5.3%). In comparison to Index stay, readmission is associated with longer length of stay (5.58 Vs 6.31 Days), and higher total hospitalization charges ($58136 Vs $62522). Independent predictors of readmission were female, comorbidities, hypertension, cirrhosis, malnutrition, acute kidney injury, shock, private insurance, and rehab transfer (Table 1).

Discussion: Multiple predictors were associated with 30-day readmission of NVUGIB in PVR-AC. Understanding these predictors can help design guidelines to reduce readmissions in high-risk patients.



Disclosures:


Shahryar Khan, MD¹, Yousaf Zafar, MD², Mashal Alam Khan, MBBS³, Hoor Umar Afridi, MBBS⁴, Ahmad Khan, MBBS⁵, Aamer Ahmad, MBBS⁶, Rizwan Afridi, ⁷. P4159 - Healthcare Utilization, Risk Factors, and 30-Day Readmission of Patients With Non-Variceal Upper Gastrointestinal Bleeding in Prosthetic Cardiac Valves on Anticoagulation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.