Outpatient management of selected patients with nonvariceal upper gastrointestinal hemorrhage has been proposed as a mechanism to decrease resource utilization and expenditures.
However, the true prevalence and outcomes of this practice have not been well evaluated in population-based studies.
Dr Gregory Cooper and colleagues identified a cohort of 9123 episodes of upper gastrointestinal hemorrhage in 2004 Medicare claims data.
Of these, 3506 were managed as outpatients.
Clinical characteristics, treatment, and outcomes were compared between inpatient and outpatient groups.
In order to adjust for potential selection bias in outpatient treatment, propensity score analysis was used to divide patients into quartiles of likelihood for inpatient treatment.
Inpatients tended to be older, with higher comorbidity scores, and were more likely to have a bleeding ulcer or tear.
Inpatients were also more likely to undergo endoscopy, including early endoscopy and therapeutics, and require surgery.
|The 30-day mortality rate was 8% in the inpatient group|
The overall 30-day mortality rate was 8% in the inpatient group, and 6% in the outpatient group.
The team noted that in the quartile of patients most likely to be managed as inpatients, the 30-day mortality rate was higher in outpatients than in inpatients.
Dr Cooper’s team concludes, “The prevalence of outpatient management of upper gastrointestinal hemorrhage in the Medicare population was almost 40%.”
“Although patients were likely selected for outpatient management based on clinical criteria, the overall mortality rate in outpatients was considerable.”
“Any potential financial benefit should be balanced against significant mortality rates, at least some of which could possibly be avoided with hospitalization.”
“More optimal selection of candidates for outpatient therapy is likely needed.”