(O-J2) Short Stay Units in the Treatment of Non-variceal Upper Gastrointestinal Bleeding

Objectives: Our study aims to evaluate the efficacy of SSU in reducing the need for hospitalization, LOS, hospital readmission, and mortality in patients with non-variceal upper gastrointestinal bleeding compared with admission to the regular ward.

Background: Emergency department overcrowding is a health, political, and economic problem of concern worldwide. Overcrowding has been associated with an increased risk of mortality. The establishment of a Short Stay Unit for conditions that cannot be treated at home but require treatment and hospitalization for up to 72 hours may be a solution. Short stay units can significantly reduce hospital length of stay for certain conditions but does not appear to be useful for other diseases. Currently, there are no studies addressing the efficacy of short stay units in the treatment of non-variceal upper gastrointestinal bleeding

Methods: This was a retrospective, single-center observational study. Medical records of patients presenting with non-variceal upper gastrointestinal bleeding to our emergency department between April 1, 2021, and September 30, 2022, were analyzed. We included patients aged > 18 years who presented to emergency department with acute upper gastrointestinal tract blood loss. The test population was divided into two groups: Patients admitted to a normal inpatient ward (control) and patients treated at SSU (intervention). Clinical and medical history data were collected for both groups. The hospital length of stay was the primary outcome. Secondary outcomes were time to endoscopy, number of blood units transfused, readmission to the hospital at 30 days, and in-hospital mortality.

Results:

Results: The analysis included 120 patients with a mean age of 70 years, 54% of whom were men. Sixty patients were admitted to short stay unit. Patients admitted to the medical ward had a higher mean age. The Glasgow-Blatchford score, used to assess bleeding risk, mortality, and hospital readmission were similar in the study groups. Multivariate analysis after adjustment for confounders found that the only factor independently associated with shorter hospital length of stay was admission to short stay unit (p < 0.0001). Admission to short stay unit was also independently and significantly associated with a shorter time to endoscopy (p < 0.001). The only other factor associated with a shorter time to endoscopy was creatinine level (p=0.05), while home treatment with proton pump inhibitors was associated with a longer time to endoscopy. Hospital length of stay, time to endoscopy, number of patients requiring transfusion, and number of units of blood transfused were significantly lower in patients admitted to short stay unit than in the control group

Conclusions: The results of the study show that treatment of non-variceal upper gastrointestinal bleeding in short stay unit can significantly reduce the time required for endoscopy, the hospital length of stay, and the number of transfused blood units without increasing mortality and hospital readmission. Treatment of on-variceal upper gastrointestinal bleeding in short stay unit may therefore help to reduce emergency department overcrowding but multicenter randomized controlled trials are needed to confirm these data.

References (Optional):

Funding (Optional): no funding