Nearly one in five HDA patients readmitted within 30 days after discharge
introduce
this acute upper gastrointestinal bleeding (HDA) is a common emergency in the United States, with two recent large national studies estimating 67 to 78 cases per 100,000 people per year. This disease places a huge burden on the healthcare system because its incidence is higher than most other gastrointestinal (GI) diseases. Furthermore, once diagnosed, it is estimated that more than three-quarters of patients with HDA require hospitalization, and its in-hospital mortality rate is the highest among gastrointestinal diseases.
In the diagnosis of HDA, there are two distinct entities, complicating the epidemiology due to various risk factors, causes, and interventions.Bleeding is Stomach or esophageal varices More often attributed to portal hypertension due to end-stage liver disease, whereas bleeding No varicose veins Represents applications remaining for other reasons.
The incidence of nonvariceal HDA is significantly higher than that of varicose veins; however, its mortality rate is lower.
Furthermore, while morbidity and mortality in nonvariceal UGD have declined dramatically in recent decades, the same has not been the case for variceal hemorrhage.
Safe discharge of patients with acute upper gastrointestinal bleeding (AGH) is an ongoing challenge for clinicians. Although bleeding can be managed acutely with endoscopy and other interventions, patients are often re-exposed to possible triggers shortly afterwards (eg, anticoagulants and ethanol), or push stimuli that do not resolve immediately (eg, portal vein Hypertension and Helicobacter pylori). Physicians must therefore have access to reported metrics, such as readmissions, rebleeds, and post-discharge mortality, so that they can effectively advise patients about risk.
In other areas of medicine, similar indicators for pneumonia, heart failure, and myocardial infarction represent quality indicators. There is also a financial case that reducing preventable readmissions will help reduce the burden on the healthcare system as a whole.
Despite the advantages of having up-to-date indicators, it is currently not possible to pool data from numerous studies on subsets of the UGIB population. This systematic review and meta-analysis summarizes the literature on readmission rates in adults discharged after HDA, stratifying clinically important subgroups.
background and goals
Upper gastrointestinal hemorrhage (UGH) is a common emergency with higher rates of hospitalization and in-hospital mortality compared with other gastrointestinal disorders. Although readmission rates are a common measure of quality, few data are available on UGIB. This study aimed to determine the readmission rate of patients discharged after HDA.
method
We searched MEDLINE, Embase, CENTRAL and Web of Science up to 16 October 2021 for randomized and nonrandomized studies reporting patient readmission after HDA according to the PRISMA guidelines. Abstract selection, data extraction and quality assessment were repeated. A random-effects meta-analysis was performed and statistical heterogeneity was measured. The GRADE framework uses a modified Downs and Black tool to determine the certainty of evidence.
result
be included 70 studies 1847 featured abstracts with moderate inter-reader reliability. In these studies, 4,292,714 patients with a mean age of 66.6 years were analyzed, 54.7% of whom were male.
HDA All-Cause Readmission Rate After 30 Days 17.4% (95% confidence interval (CI) 16.7–18.2%), stratification showed a higher incidence of HDA Varicose veins (19.6% (95% CI: 17.6–21.5%)) than HDA not varicose veins (16.8% (95% CI: 16.0–17.5%)).
Only one-third were readmitted for HDA recurrence (4.8% (95% CI 3.1-6.4%)). HDA due to bleeding peptic ulcer The 30-day readmission rate was lowest (6.9% (95% CI: 3.8–10.0%)). The quality of evidence for all outcomes was very low or very low.
Forest plot of all-cause mortality after 30 days