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ADMISSION DISCIPLINE DOES AFFECT OUTCOMES FOR PATIENTS PRESENTING WITH GASTROINTESTINAL BLEEDING
Koy Min Chue*1, Bridget Si Min Ng3, Jonathan Yongwei Boey3, Yiong Huak Chan2, Guo Wei Kim1, Mikael Hartman1, Jimmy B. So1
1Surgery, National University Health System, Singapore, Singapore; 2Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Introduction
Bleeding of the gastrointestinal tract (BGIT) is a common medical emergency. Treatment for BGIT is multidisciplinary, which encompasses medical, endoscopic, radiological and surgical modalities. In many hospitals, both physicians and surgeons received training in therapeutic endoscopy. Thus, there is significant overlap in the disposition of patients presenting with BGIT, as they can be managed by either a medical or surgical team. Hence, this study aims to investigate the impact of admitting discipline on patient outcomes in BGIT.
Methodology
A retrospective review of a 2-year tertiary institution database was conducted. All patients with a diagnosis code correlating with possible BGIT were reviewed. Differences in outcomes between medical admitting disciplines (MED) or surgical admitting disciplines (SUR) were compared matched by the quartiles of the propensity score (consisting of all premorbid, presenting symptoms, hemodynamic and demographic parameters) within each discipline.
Results
A total of 1383 patients were included (MED (n=853); SUR (n=530)). Patients who were admitted to MED had significantly more comorbidities, were more hemodynamically unstable and had a higher proportion presenting with symptoms more closely associated with upper BGIT. Yet, even after adjusting for these differences by matching within group quartiles, patients with BGIT admitted to SUR appeared to have a shorter length of stay (p<0.001), decreased 30-day readmissions (p<0.001), decreased 30-day readmissions due to BGIT ((p=0.019), decreased 30-day mortality (p=0.027) and a higher likelihood of successful endoscopy (p<0.001). There was a trend suggesting decreased complications for patients admitted to SUR but this did not reach statistical significance (p=0.060). However, patients admitted to MED had a shorter time interval to endoscopy (p<0.001).
Conclusion
While there may still be baseline differences in patient characteristics between MED and SUR, admission to a surgical discipline appeared to be associated with improved patient outcomes. Future prospective randomized controlled studies are required to confirm such findings.
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