P0741 - Comparative Analysis of Patients With Lower GI Bleed Undergoing Early versus Late Colonoscopy: A National Readmission Database Study

Umesh Bhagat, MD¹, Ankit Agrawal, MD¹, Prabhat NA. Kumar, MD², Mounir Ibrahim, MD¹, Shalini Tripathi, MD¹, Archana Kahrel, MD¹, Omar Saab, MD¹, Anshu Priya, MD³, Prashanthi N. Thota, MD¹, Madhusudhan R. Sanaka, MD^1
1Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, FL; ³Charleston Area Medical Center, Charleston, WV

Introduction: People admitted to the hospital with Lower GI Bleed (LGIB) need intervention. As per the current guidelines it is recommend that patients requiring colonoscopy undergo non emergent colonoscopy, this guideline is based on moderate to low body of evidence. The studies looking at readmission rates based on intervention is lacking. Here we tried to see if there are any differences between rates of readmission with LGIB based on timing of intervention received on the index admission.

Methods: We queried the NRD database from 2016 to 2020, using ICD-10-CM coding system to identify the patients with a primary diagnosis of LGIB, who underwent either early (< 24hours) or late colonoscopy (2nd to 10th day of admission). The primary outcome was cumulative incidence(CI) of readmission in 30 days with LGIB. Secondary outcome was rates of colectomy and mortality. Survival analysis was done to calculate the CI and HR of readmission.

Results: Total of 618,229 patients were admitted with LGIB who underwent colonoscopy, out of which 292,032 underwent early colonoscopy and 398,758 underwent colonoscopy after 24 hours. In the early cohort 20,030 were readmitted with LGIB in 30days compared to 30,215 in later cohort. The cumulative incidence of readmission in early cohort was 5.6% compared to 6% in later cohort (P< 0.01) The hazard ratio of readmission was 1.08 (CI:1.05-1.10, P< 0.01) in later cohort compared to early cohort. Rates of colectomy was 6.67% in early cohort compared to 4.24% in later cohort (P< 0.01). Mortality remained similar with 1.6% (P< 0.01) in both cohorts. Further analysis on early cohort who were readmitted showed rates of colectomy to be 9.2% and mortality to be 1.39% if they underwent colonoscopy within 24 hours compared to 5.19% and 2.52% if they underwent colonoscopy later (P< 0.01). Similarly in later cohort rates of colectomy was 12.03% and mortality was 1.32% if they underwent colonoscopy within 24 hours of readmission compared to 3.95% and2.48% if they underwent colonoscopy later (P< 0.01)

Discussion: LGIB has higher rates of readmission and mortality. Here we report that patients undergoing colonoscopy later than 24 hrs had higher risk of readmission with LGIB compared to those who underwent colonoscopy within 24 hrs.It was interesting to find that rates of colectomy and mortality differed in readmitted patients with colectomy rates higher in patients receiving early colonoscopy and mortality higher in patients receiving colonoscopy later.



Disclosures:


Umesh Bhagat, MD¹, Ankit Agrawal, MD¹, Prabhat NA. Kumar, MD², Mounir Ibrahim, MD¹, Shalini Tripathi, MD¹, Archana Kahrel, MD¹, Omar Saab, MD¹, Anshu Priya, MD³, Prashanthi N. Thota, MD¹, Madhusudhan R. Sanaka, MD¹. P0741 - Comparative Analysis of Patients With Lower GI Bleed Undergoing Early versus Late Colonoscopy: A National Readmission Database Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.