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Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital

BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) has a high mortality rate and requires efficient and directed acute management. This project aimed to assess patient outcomes following changes to UGIB management protocols at Northern Hospital, Victoria, Australia. Changes involved streamli...

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Autores principales: Papadinas, Adrianna, Butt, Joshua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Publishing Asia Pty Ltd 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411648/
https://www.ncbi.nlm.nih.gov/pubmed/32782947
http://dx.doi.org/10.1002/jgh3.12303
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author Papadinas, Adrianna
Butt, Joshua
author_facet Papadinas, Adrianna
Butt, Joshua
author_sort Papadinas, Adrianna
collection PubMed
description BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) has a high mortality rate and requires efficient and directed acute management. This project aimed to assess patient outcomes following changes to UGIB management protocols at Northern Hospital, Victoria, Australia. Changes involved streamlining management under a single inpatient unit, earlier endoscopy, blood transfusion thresholds, and risk stratification. METHODS: This was a cohort study of 400 patients aged ≥18 years admitted to Northern Hospital who underwent endoscopy for acute UGIB. Data of preprotocol changes (Group 1) and prospectively postprotocol changes (Group 2) were collected retrospectively. Primary outcomes were inpatient mortality, rebleeding, radiologic or surgical intervention, and endoscopic reintervention. Secondary outcomes included length of stay (LOS) ≥4 days and blood units transfused. Univariate analyses were conducted comparing groups and associations between variables and outcomes, followed by multivariate analyses for each outcome. RESULTS: There was no difference in mortality on multivariate analysis (P = 0.95). Rebleeding reduced by 4% (adjusted odds ratio [AOR] 0.48; P = 0.03), LOS ≥4 days reduced by 15.1% (AOR 0.46; P < 0.00) and median blood units transfused decreased with adjusted incidence rate ratio of 0.81 (P = 0.00). Early endoscopy (i.e. ≤12 h) for all patients increased by 15% (P < 0.00) and there were 12% more high‐risk patients (i.e. Glasgow–Blatchford score ≥ 12) in Group 2 (P = 0.01). CONCLUSION: Following changes to UGIB protocols at this Australian hospital, endoscopic times decreased with reductions in rebleeding, LOS ≥4 days, and blood transfusion rates. These findings demonstrate improved outcomes after the implementation of new treatment targets focusing on streamlined care of patients presenting with UGIB.
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spelling pubmed-74116482020-08-10 Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital Papadinas, Adrianna Butt, Joshua JGH Open Original Articles BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) has a high mortality rate and requires efficient and directed acute management. This project aimed to assess patient outcomes following changes to UGIB management protocols at Northern Hospital, Victoria, Australia. Changes involved streamlining management under a single inpatient unit, earlier endoscopy, blood transfusion thresholds, and risk stratification. METHODS: This was a cohort study of 400 patients aged ≥18 years admitted to Northern Hospital who underwent endoscopy for acute UGIB. Data of preprotocol changes (Group 1) and prospectively postprotocol changes (Group 2) were collected retrospectively. Primary outcomes were inpatient mortality, rebleeding, radiologic or surgical intervention, and endoscopic reintervention. Secondary outcomes included length of stay (LOS) ≥4 days and blood units transfused. Univariate analyses were conducted comparing groups and associations between variables and outcomes, followed by multivariate analyses for each outcome. RESULTS: There was no difference in mortality on multivariate analysis (P = 0.95). Rebleeding reduced by 4% (adjusted odds ratio [AOR] 0.48; P = 0.03), LOS ≥4 days reduced by 15.1% (AOR 0.46; P < 0.00) and median blood units transfused decreased with adjusted incidence rate ratio of 0.81 (P = 0.00). Early endoscopy (i.e. ≤12 h) for all patients increased by 15% (P < 0.00) and there were 12% more high‐risk patients (i.e. Glasgow–Blatchford score ≥ 12) in Group 2 (P = 0.01). CONCLUSION: Following changes to UGIB protocols at this Australian hospital, endoscopic times decreased with reductions in rebleeding, LOS ≥4 days, and blood transfusion rates. These findings demonstrate improved outcomes after the implementation of new treatment targets focusing on streamlined care of patients presenting with UGIB. Wiley Publishing Asia Pty Ltd 2020-02-05 /pmc/articles/PMC7411648/ /pubmed/32782947 http://dx.doi.org/10.1002/jgh3.12303 Text en © 2020 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Papadinas, Adrianna
Butt, Joshua
Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital
title Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital
title_full Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital
title_fullStr Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital
title_full_unstemmed Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital
title_short Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital
title_sort outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an australian hospital
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411648/
https://www.ncbi.nlm.nih.gov/pubmed/32782947
http://dx.doi.org/10.1002/jgh3.12303
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