CHICAGO — Patients with acute bleeding of the lower intestinal tract have a shorter hospitalization if they undergo colonoscopy on the first day of admission, according to a nationwide study by Harvard Medical School researchers.
Early colonoscopy also was associated with decreased hospital charges, Lisa Strate, M.D., reported at the annual Digestive Disease Week.
The study was based on a 20% sample of a nationally representative cohort called the Healthcare Cost and Utilization Project's 2002 National Inpatient Sample. This database contains discharge data from 995 U.S. community hospitals in 35 states, according to its sponsor, the Agency for Healthcare Research and Quality.
Among more than 255,000 discharged patients who had a principal diagnosis of acute lower intestinal bleeding, 28% had colonoscopy on hospital day 1, called early colonoscopy. Another 22% of the total cohort underwent colonoscopy after day 1.
Patients who underwent early colonoscopy had a mean stay of 5 days vs. 7 days for patients who did not have the procedure or had it after the first hospital day, Dr. Strate said.
Reduced stay did not appear to result from therapeutic interventions, because colonoscopy with endoscopic hemostasis was not associated with shorter length of stay, she reported. This finding confirmed the results of two single-institution studies (Am. J. Gastroenterol. 2003;98:317–22; Gastrointest. Endosc. 2003;58:841–6).
“We hypothesize that doing an early colonoscopy and finding no source of active or ongoing bleeding offered reassurance and led to an earlier discharge,” Dr. Strate said in an interview. “Patients with high-risk stigmata were observed for longer periods.”
In a separate presentation, Don Rockey, M.D., professor of gastroenterology at Duke University and an author of one of the previous studies (Gastrointest. Endosc. 2003;58:841–6), commented on early colonoscopy in this patient population. “Urgent colonoscopy translates to decreased hospital stay and costs,” he said.
Longer hospital stay for patients with acute lower intestinal bleeding is associated with higher mortality, Dr. Strate reported in another study at the meeting that used the National Inpatient Sample.