Gastroenterology
Volume 136, Issue 1 , Pages 108-114 , January 2009

Outpatient Management of Nonvariceal Upper Gastrointestinal Hemorrhage: Unexpected Mortality in Medicare Beneficiaries

Presented in part at Digestive Disease Week, San Diego, California, May 21, 2008, and published in abstract form in Gastroenterology 2008;134:A730.

  • Gregory S. Cooper

      Affiliations

    • Corresponding Author InformationAddress requests for reprints to: Gregory S. Cooper, MD, Division of Gastroenterology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Wearn 247, Cleveland, Ohio 44106-5066. Phone: (216) 844-5386; fax: (216) 983-0347
  • ,
  • Tzyung Doug Kou
  • ,
  • Richard C.K. Wong

Received 19 June 2008 ,Accepted 18 September 2008.

References 

  1. Agency for Healthcare Research and Quality. HCUPnet: healthcare cost and utilization project. http://hcupnet.ahrq.gov/Accessed July 18, 2008
  2. Bjorkman DJ, Zaman A, Fennerty MB, et al. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc. 2004;60:1–8
  3. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–1511
  4. Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003;139:843–857
  5. Spiegel BMR, Vakil NB, Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal hemorrhage: is sooner better?. Arch Intern Med. 2001;161:1393–1404
  6. Longstreth GF, Feitelberg SP. Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage. Lancet. 1995;345:108–111
  7. Lee JG, Turnipseed S, Romano PS, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc. 1999;50:755–761
  8. Lai KC, Hui WM, Wong BCY, et al. A retrospective and prospective study on the safety of discharging selected patients with duodenal ulcer bleeding on the same day as endoscopy. Gastrointest Endosc. 1997;45:26–30
  9. Cebollero-Santamaria F, Smith J, Gioe S, et al. Selective outpatient management of upper gastrointestinal bleeding in the elderly. Am J Gastroenterol. 1999;94:1242–1247
  10. Almela P, Benages A, Peiro S, et al. Outpatient management of upper digestive hemorrhage not associated with portal hypertension: a large prospective cohort. Am J Gastroenterol. 2001;96:2341–2348
  11. Cipolletta L, Bianco MA, Rotondano G, et al. Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc. 2002;55:1–5
  12. Klebl FH, Bregenzer N, Schofer L, et al. Comparison of inpatient and outpatient upper gastrointestinal haemorrhage. Int J Colorectal Dis. 2005;20:368–375
  13. Abraham NS, Cohen DC, Rivers B, et al. Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti-inflammatory drug prescription. Aliment Pharmacol Ther. 2006;24:299–306
  14. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–383
  15. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619
  16. Klabunde CN, Potosky AL, Legler JM, et al. Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000;53:1258–1267
  17. Rosenbaum PR, Rubin DB. Reducing bias in observational studies using subclassification on the propensity score. J Am Stat Assoc. 1984;79:516–524
  18. Abraham NS, Hartman C, Castillo D, et al. Effectiveness of national provider prescription of PPI gastroprotection among elderly NSAID users. Am J Gastroenterol. 2008;103:323–332
  19. Lanas A, Perez-Aisa MA, Feu F, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 2005;100:1685–1693
  20. Thomsen RW, Riis A, Christensen S, et al. Outcome of peptic ulcer bleeding among users of traditional non-steroidal anti-inflammatory drugs and selective cyclo-oxygenase-2 inhibitors. Aliment Pharmacol Ther. 2006;24:1431–1438
  21. Marmo R, Koch M, Cipolleta L, et al. Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study. Am J Gastroenterol. 2008;103:1639–1647
  22. Gralnek IM, Dulai GS. Incremental value of upper endoscopy for triage of patients with acute non-variceal upper GI hemorrhage. Gastrointest Endosc. 2004;60:9–14
  23. Rockall TA, Logan RFA, Devlin HB, et al. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. BMJ. 1995;311:222–226
  24. Rockall TA, Logan RFA, Devlin HB, et al. Variation in outcome after acute upper gastrointestinal haemorrhage. Lancet. 1995;346:346–350
  25. Moreno P, Jaurrieta E, Aranda H, et al. Efficacy and safety of an early discharge protocol in low-risk patients with upper gastrointestinal bleeding. Am J Med. 1998;105:176–181
  26. Das A, Ben Menachem T, Farooq FT, et al. Artificial neural network as a predictive instrument in patients with acute nonvariceal upper gastrointestinal hemorrhage. Gastroenterology. 2008;134:65–74
  27. Cooper GS, Yuan Z, Rosenthal GE, et al. Lack of gender and racial differences in surgery and mortality in hospitalized Medicare beneficiaries with bleeding peptic ulcer. J Gen Intern Med. 1997;12:485–490
  28. Xu W, Hood HM, Burgess PA. The description of outcomes in Medicare patients hospitalized with peptic ulcer disease. Am J Gastroenterol. 2000;95:264–270
  29. In:  Iezzoni LI editors. Risk adjustment for measuring health care outcomes. Ann Arbor, MI: Health Administration Press; 1994;p. 119–175
  30. Cooper GS, Chak A, Lloyd LE, et al. The accuracy of diagnosis and procedural codes for patients with upper gastrointestinal hemorrhage. Gastrointest Endosc. 2000;51:423–426
  31. Raiford DS, Gutthann SP, Garcia Rodriguez LA. Positive predictive value of ICD-9 codes in the identification of cases of complicated peptic ulcer disease in the Saskatchewan Hospital automated database. Epidemiology. 1996;7:101–104
  32. Fisher ES, Whaley FS, Krushat WM, et al. The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992;82:243–248

 The authors disclose the following: Supported in part by a Research and Outcomes and Effectiveness Award from the American Society for Gastrointestinal Endoscopy. The sponsor had no role in the design, conduct, or reporting of the results.

PII: S0016-5085(08)01699-5

doi: 10.1053/j.gastro.2008.09.030

Gastroenterology
Volume 136, Issue 1 , Pages 108-114 , January 2009