The treatment of peptic ulcer bleeding is complex, and mortality remains high.
Dr Steffen Rosenstock and colleagues from Denmark presented results from a nationwide initiative to monitor and improve the quality of care in peptic ulcer bleeding.
All Danish hospitals treating peptic ulcer bleeding patients between 2004 and 2011 prospectively registered demographic, clinical, and prognostic data.
The team evaluated quality of care using 8 process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.
|Crude 30-day mortality was unchanged|
|American Journal of Gastroenterology|
A total of 13,498 peptic ulcer bleeding patients were included, of which one-quarter were in-hospital bleeders.
The research team found that preadmission use of anticoagulants, multiple coexisting diseases, and the American Society of Anesthesiologists scores increased between 2004 and 2011.
Considerable improvements were observed for most quality of care indicators over time.
The team observed that endoscopic treatment was successful with primary hemostasis achieved in more patients, endoscopy delay for hemodynamically unstable patients decreased during this period, and fewer patients underwent open surgery.
The team noted that after controlling for time changes in prognostic factors, rebleeding rates improved.
The research team found that crude 30-day mortality was unchanged, whereas adjusted mortality decreased nonsignificantly over time.
Dr Rosenstock's team concludes, "Quality of care in peptic ulcer bleeding has improved substantially in Denmark, but the 30-day mortality remains high."
"Future initiatives to improve outcomes may include earlier endoscopy, having fully trained endoscopists on call, and increased focus on managing coexisting disease."