Medical care setting is associated with survival in acute upper gastro-intestinal bleeding: A cohort study

Abstract

Background: There are limited data on the effect of the medical care setting on survival in patients admitted with acute upper gastrointestinal bleeding.

Aims: To identify the organisational and care setting which provides the optimal survival in patients with acute upper gastrointestinal bleeding.

Methods: A retrospective observational study of administrative data from a cohort of patients admitted to a Regional or Local hospital, and cared for in a gastroenterology or general ward.

Primary outcome: 30 day survival for non-variceal bleeding and 42 day survival for variceal bleeding.

Results: Out of 3368 patients, the source of bleeding was non-variceal in 2980 (88.5%). Survival, adjusted for clinical and organisational factors, was higher in patients admitted to a gastroenterology ward vs other wards (OR = 2.02 p < 0.0006). Management in a gastroenterology ward in a Regional hospital provided a higher survival rate (95.6% ± 0.08) vs a non-gastroenterology ward in a Local hospital (92.9% ± 0.05 p < 0.01) or a non-gastroenterology ward in a Regional hospital (89.5% ± 0.01 p < 0.0001). Survival (94.0% ± 1.6) in a Local hospital with a gastroenterology ward was significantly higher than in a Regional hospital without (89.5% ± 1.1) p < 0.01.

Conclusion: Survival was optimal for patients treated in a gastroenterology ward independently of Regional or Local hospital setting.

Keywords: Acute upper gastro intestinal bleeding; Health care organisational setting; Specialist care; Survival.