P2501 - Colonoscopy Adverse Events in Urban versus Rural Hospitals: Retrospective Cohort Analysis From Nationwide Data

Nooraldin Merza, MD¹, Brian P. Rutledge, MD², Alsadiq Al-Hillan, MD³, Muna Shaaeli, MD⁴, Mazin Saadaldin, MD⁵, Tarek Naguib, MD^5
1Wayne State University, Dearborn, MI; ²Wayne State University, Detroit Medical Center, Detroit, MI; ³Baylor College of Medicine/Beaumont Health (Royal Oak) Program, Houston, TX; ⁴Beaumont Hospital, Dearborn, MI; ⁵Texas Tech University Health Sciences Center, Amarillo, TX

Introduction: Endoscopic examination plays a vital role in evaluating upper and lower gastrointestinal problems and in screening for colon cancer. Major hospitals and urban centers are often recognized for offering advanced treatment options, but whether these centers provide better outcomes regarding colonoscopy procedures than rural hospitals is unclear. This study examines the association of hospital locations with the outcomes

Methods: A retrospective analysis utilizing the de-identified data from the National Inpatient Sample (NIS) was used to analyze patients hospitalized with esophageal variceal bleeding from 2004 through 2014. Hospital encounters for colonoscopy procedures were identified using the International Classification of Diseases (ICD-9) diagnostic codes; codes‘4523’ ‘V7651’. The NIS is a component of the Healthcare Cost and Utilization Project, a national health care database developed through a partnership among federal and state governments and health care institutions sponsored by the Agency for Healthcare Research and Quality. We compared the primary adverse events, including perforations, bleeding, splenic injury, atrial fibrillation, aspiration pneumonia, and sepsis. Categorical variables were compared using the chi-square test, and continuous variables were compared using the t-test

Results: A total of 484,748 admissions were identified with the colonoscopy procedure, of which 484,282 done in urban hospitals and 60,466 in rural hospitals. When we compared the outcomes, we noticed higher rates in urban hospitals than rural hospitals; Colonic/Intestinal perforation (0.4% vs. 0.3%, P. value < 0.001), Atrial fibrillation (14.8% vs. 13.9%, p < 0.001), sepsis (3.2% vs.2.2%, P. value < 0.001), syncope and collapse (2.2% vs. 1.9%), Death rate (1.7% vs. 1.2%), and length of stay (7.19 days vs. 5.78 days). Total hospital charges were significantly higher in urban hospitals (43956 US Dollars vs. 22491 US Dollars). While Similar risks without statistical significance for pneumonia (5.1% vs. 5.0 P. Value 0.714)

Discussion: Our analysis is showing that urban hospitals' colonoscopy procedures were associated with higher rates of Perforations, Cardiac arrhythmia, Total hospital charges, and length of stay. We should mention that the severity and medical comorbidities of the cases were not considered for this preliminary analysis; therefore further studies would be necessary to examine the clinical relevance of these findings

	Rural	Urban	p
N	60466	424282
Age groups (%)
Less than 35	2153 (3.6)	19314 (4.6)	< 0.001
35 - 49	6060 (10.0)	50772 (12.0)	< 0.001
50 - 64	12550 (20.8)	100273 (23.6)	< 0.001
65 - 79	21890 (36.2)	143418 (33.8)	< 0.001
> 79 years	17796 (29.4)	110454 (26.0)	< 0.001
Sex (%)
Female	34898 (57.8)	239066 (56.4)	< 0.001
Male	25525 (42.2)	185034 (43.6)	< 0.001
Race (%)
White	34467 (80.4)	230375 (66.5)	< 0.001
Black	5028 (11.7)	60231 (17.4)	< 0.001
Hispanic	1859 (4.3)	37231 (10.7)	< 0.001
Asian	254 (0.6)	8589 (2.5)	< 0.001
Native American	626 (1.5)	1441 (0.4)	< 0.001
Other	630 (1.5)	8693 (2.5)	< 0.001
Screening indication colonoscopy (%)	179 (0.3)	1978 (0.5)	< 0.001
Colonic perforation/Small intestine perforation (%)	243 (0.4)	1245 (0.3)	< 0.001
Bleeding (%)	8852 (14.6)	52810 (12.4)	< 0.001
Splenic Injury (%)	12 (0.0)	82 (0.0)	1
Syncope and collapse (%)	1159 (1.9)	9196 (2.2)	< 0.001
Atrial fibrillation (%)	8386 (13.9)	62762 (14.8)	< 0.001
Nausea (%)	1194 (2.0)	6287 (1.5)	< 0.001
Abdominal pain (%)	617 (1.0)	3899 (0.9)	0.016
Anal or Rectal pain (%)	76 (0.1)	418 (0.1)	0.059
Pneumonia (%)	3054 (5.1)	21278 (5.0)	0.714
Sepsis (%)	1324 (2.2)	13493 (3.2)	< 0.001
Length of stay (mean (SD))	5.78 (5.40)	7.19 (8.70)	< 0.001
Total charges (mean (SD))	22491.15 (26663.75)	43956.01 (69585.26)	< 0.001
Died (%)	727 (1.2)	7011 (1.7)	< 0.001
Discharged alive (%)	59726 (98.8)	417039 (98.3)	< 0.001

Table: Comparing the admissions were identified with the colonoscopy procedure, of which 484,282 done in urban hospitals and 60,466 in rural hospitals


Disclosures:
Nooraldin Merza indicated no relevant financial relationships.
Brian Rutledge indicated no relevant financial relationships.
Alsadiq Al-Hillan indicated no relevant financial relationships.
Muna Shaaeli indicated no relevant financial relationships.
Mazin Saadaldin indicated no relevant financial relationships.
Tarek Naguib indicated no relevant financial relationships.


Nooraldin Merza, MD¹, Brian P. Rutledge, MD², Alsadiq Al-Hillan, MD³, Muna Shaaeli, MD⁴, Mazin Saadaldin, MD⁵, Tarek Naguib, MD⁵. P2501 - Colonoscopy Adverse Events in Urban versus Rural Hospitals: Retrospective Cohort Analysis From Nationwide Data, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.