Loyola University Medical Center; Mercy Hospital and Medical Center Chicago, IL
Mohamad A. Minhem, MD1, Ahmad Nakshabandi, MD2, Mark Mattar, MD3, Joseph J. Jennings, MD3; 1Loyola University Medical Center; Mercy Hospital and Medical Center, Chicago, IL; 2Georgetown University Medical Center, Washington, DC; 3MedStar Georgetown University Hospital, Washington, DC
Introduction: Same-day dual endoscopy (SAME-DE) is a common procedure performed in the practice of gastroenterologists. The indications of SAME-DE are diverse and can include gastrointestinal hemorrhage (GIH) from an unidentified source, anemia, and suspicion for GI malignancy. We aim to study outcomes such as mortality, length of stay (LOS) and cost of hospital care (COC) for inpatients undergoing SAME-DE and compare it to patients undergoing EGD and colonoscopy on separate days. Methods: This study was based on the national inpatient sample (NIS) 2016 database. All adult inpatients who underwent both EGD and colonoscopy during a hospital admission are included. Patients were categorized into comparison arms, SAME-DE and separate days dual endoscopy (SEP-DE). Outcomes studied were LOS, COC, and inpatient mortality. Medians were represented with interquartile range (IQR). Multivariate binary logistic and linear regression were performed to adjust for age, gender, white race, income, insurance, heart failure, renal failure, cirrhosis, GI neoplasm, and SAME-DE. Survival analysis was performed to plot time to discharge. Results: Out of 49,959 patients who underwent inpatient dual endoscopy, 33140 (66.3%) were SAME-DE. The median time to SAME-DE (zero is the day of admission) was 2 [IQR: 1,4] days. For SEP-DE, time to EGD and colonoscopy were 1[1,3] and 3[2,4] days, respectively. SAME-DE patients were slightly younger (64.9±16.2 VS 67.6±15.0 years old, p< 0.001) and had more females (53.4% VS 50.1%, p< 0.001), similar white race and high income compared to SEP-DE. GIH was less prevalent in SAME-DE compared to SEP-DE (49.8% VS 67.1%, p< 0.001) therefore analysis of outcomes was stratified based on GIH or anemia requiring RBC transfusion. Results of outcomes are presented in Table 1. For both groups of patients who had or did not have GIH/Anemia, SAME-DE had significantly less LOS and COC on multivariate analysis. Similarly, SAME-DE had faster discharge from the hospital based on the survival to discharge plot (Figure 1). In patients without GIH/Anemia, SAME-DE had lower inpatient mortality compared to SEP-DE (1.1% VS 1.7%, aOR=0.67, p=0.01); while in patients with GIH/Anemia, SAME-DE had similar mortality. Discussion: Inpatient SAME-DE appears to be a more safe and efficient method compared to SEP-DE. Performing SAME-DE helps in decreasing the healthcare bill and ensuring faster discharge from hospitals and may have a mortality benefit in patients without GIH.
Table 1. Results of bivariate and multivariate analysis for the outcomes based on the timing pattern of dual endoscopy
Disclosures: Mohamad Minhem indicated no relevant financial relationships. Ahmad Nakshabandi indicated no relevant financial relationships. Mark Mattar indicated no relevant financial relationships. Joseph Jennings indicated no relevant financial relationships.