Early Colonoscopy in Hospitalized Patients With Acute Lower Gastrointestinal Bleeding: A Nationwide Analysis

BACKGROUND: Performing colonoscopy within 24 h of presentation to the hospital is the accepted standard of care for patients with an acute lower gastrointestinal bleed (LGIB). Previous studies have failed to demonstrate the benefit of early colonoscopy (EC) on mortality. In this study, we wanted to see if there was a change in inpatient deaths (primary outcome), length of stay (LOS), and hospitalization charges (TOTCHG) (secondary outcomes) with EC compared to previous studies. METHODS: Adults diagnosed with LGIB were identified using the International Classification of Disease 10th Revision codes from the National Inpatient Sample database for 2016 to 2019. EC was defined as the procedure performed within 24 h of hospitalization. Delayed colonoscopy (DC) was defined as a procedure performed after 24 h of presentation. The patient population was divided into EC and DC groups, and the effects of several covariates on outcomes were measured using binary logistic and multivariate regression analysis. Inverse probability treatment weighting (IPTW) was performed to adjust for confounding covariates. RESULTS: There were 1,549,065 cases diagnosed with LGIB, of which 285,165 cases (18.4%) received a colonoscopy. A total of 107,045 (6.9%) patients received early colonoscopies. EC was associated with decreased inpatient deaths (0.9% in EC, and 1.4% in DC, P < 0.001). However, upon IPTW, this difference was not present. EC was associated with a decreased LOS (median 3 days vs. 5 days, P < 0.001) and TOTCHG (median $32,037 vs. $44,092, P < 0.001). Weekend admissions (WA) were associated with fewer EC (31.6% in WA, and 39.5% in non-WA, P < 0.001). WA did not affect inpatient deaths. CONCLUSIONS: EC was not associated with decreased inpatient deaths. There was no difference in endoscopic interventions in both EC and DC groups. The difference in inpatient deaths observed between the two groups was not evident upon adjusting the results for confounders. EC was associated with a decreased LOS, and TOTCHG in patients with LGIB.