Oral 7 Does Obesity Impact Mortality and Other Outcomes in Patients With Upper Gastrointestinal Hemorrhage? A Nationwide Analysis
Author Insight from Marwan S. Abougergi, MD, Catalyst Medical Consulting
What’s new here and important for clinicians?
Obesity has been shown to negatively impact prognosis for a wide range of medical conditions, including breast cancer and bipolar disease, as well as surgical interventions including coronary artery bypass grafting. To our knowledge, no previous study has examined the national impact of obesity on non-variceal upper gastrointestinal hemorrhage outcomes. We used the largest publicly available national inpatient database to study the outcomes of obese vs. non-obese patients with upper gastrointestinal bleeding.
We found that obese and non-obese patients had similar in-hospital mortality rates. However, obese patients were more likely to undergo an in-hospital endoscopy and receive endoscopic treatment, and to need ICU-level care and experience hemorrhagic shock compared with non-obese patients. In addition, obese patients had a lower rate of endoscopies performed within the first 24 hours of admission compared with non-obese patients, with similar rates of surgery and radiologic interventions. Finally, obese patients had longer lengths of hospital stay and higher total hospitalization charges compared with non-obese patients.
When looking at the reasons for upper gastrointestinal hemorrhage, obese and non-obese patients had similar upper gastrointestinal hemorrhage diagnoses. The top four diagnoses for both groups were: unspecified hemorrhage of gastrointestinal tract/hematemesis, gastric/duodenal ulcer with hemorrhage, Mallory Weiss tear, and gastritis with hemorrhage.
Obese patients experienced more hemorrhagic shock and required more frequent intensive care unit level care compared with non-obese patients. While the limitations of the database does not allow to directly ascertain the reasons for those findings, we found that obese patients suffered from more comorbidities, including diabetes mellitus, myocardial infarction, congestive heart failure, and cerebrovascular accidents that are usually managed with anticoagulation and anti-platelets medications. Those medications could have potentially led to more severe hemorrhage at presentation. This may also explain the increased frequency of endoscopic interventions for obese, compared with non-obese, patients. Interestingly, obese patients experienced delays in undergoing endoscopic procedures. The reasons for these delays are unclear, but may be related to lengthier resuscitation needed before endoscopy, the patients’ comorbidities, or difficulties with sedation/need for endotracheal intubation. Nonetheless, endoscopic interventions appear to control hemorrhage equally well for obese and non- obese patients, since the rate of radiologic intervention and surgery were similar between the two groups.
In addition, we found that total hospitalization charges were directly dependent on length of stay, even after adjusting for multiple factors including patients’ characteristic (e.g. age, Charlson comorbidity index) and hospital characteristics ( e.g. size, teaching status). However, we also found that the proportion of endoscopies performed within 24 hours of admission was lower for obese, compared with non-obese, patients. Increasing the number of endoscopies performed within 24 hours is thus important not only because the American College of Gastroenterology clinical guidelines recommend it, but because it is helps reduce length of stay and ultimately decreases cost.
In conclusion, unlike in many other medical conditions, obesity is not a negative prognostic factor for in-hospital mortality for patients with upper gastrointestinal hemorrhage. Obese patients do have an increase in intensive care unit admissions, incidence of hemorrhagic shock, and resource utilization, including length of stay and total hospitalization charges. More frequent in-hospital endoscopies and endoscopic interventions performed for obese patients could potentially explain the similar overall clinical outcomes.
What do patients need to know?
Obesity does not increase the risk of death during a hospitalization for upper gastrointestinal bleeding. However, obese patients become sicker than non-obese patients during an upper gastrointestinal bleeding episode and require more care in the intensive care unit and more upper endoscopies to stop the bleeding. In addition, obese patients tend to stay for a longer time in the hospital and incur higher payments for the hospital care compared with non-obese patients.
Author Contact Marwan Abougergi, MD, Catalyst Medical Consulting
mabougergi@catalystsclinic.com
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