30-Day Readmission Rates Are High After Discharge for Upper GI Bleeding

Almost 20% of patients admitted to the hospital with upper gastrointestinal (GI) bleeding are readmitted within 30 days of discharge, according to study findings published in the Journal of Gastroenterology and Hepatology.

Acute upper GI bleeding is a common medical emergency, often treated through endoscopy or other interventions. However, readmission due to reexposure to causative factors, such as anticoagulation or lack of complete eradication of the initial causative factor, may predispose patients with upper GI bleeding to an increased risk for readmission after discharge.

Researchers at the University of Calgary in Canada stated that “informed metrics such as readmission, rebleed, and mortality rates after discharges are important for physicians to have access to, so they can counsel patients effectively on their risk.”

To assess these metrics, they conducted a systematic review and meta-analysis of the literature from the MEDLINE, Embase, CENTRAL, and Web of Science databases from inception until October 21, 2021. They included 70 of 1,847 identified randomized and nonrandomized studies, which reported hospital readmission following initial admission for an upper GI bleed.

These 70 included studies reported readmission outcomes of a combined cohort of 4,292,714 patients with a mean age of 66.6 years (men, 54.7%). Most (65.7%) studies were conducted in the United States.

Approximately 29 (41.4%) of the studies investigated variceal upper GI bleeding, while 30 (42.9%) assessed nonvariceal upper GI bleeds. The remainder of the studies did not specify the type of upper GI bleed. Around 375,356 patients (men, 68.1%) experienced variceal bleeding, while 3,707,450 patients (men, 53.8%) experienced nonvariceal bleeding.

All-cause readmission rates within 30 days of initial discharge following upper GI bleeding were approximately 17.4% (95% CI, 16.7%-18.2%), with a slightly higher rate of readmission for those who previously experienced variceal upper GI bleeds compared with nonvariceal upper GI bleeds (19.6% vs 16.8%).

Almost one-third (4.8%) of those readmitted experienced recurrent upper GI bleeding, with the lowest readmission rate (6.9%; 95% CI, 3.8%-10.0%) occurring among patients with peptic ulcer bleeding.

Additionally, 9 of the 70 studies reported 30-day all-cause mortality, which was calculated at 3.7% (95% CI, 2.5%-4.9%). Patients with variceal upper GI bleeding demonstrated an all-cause, 30-day mortality rate of 2.7% (95% CI, 0.0%-5.7%), while patients with nonvariceal upper GI bleeding demonstrated an all-cause, 30-day mortality rate of 1.8% (95% CI, 0.7%-2.9%).

“Almost one in five patients discharged after an [upper GI bleed] are readmitted within thirty days,” the study authors wrote. “This data should prompt clinicians to reflect on their own practice to identify areas of strength or improvement.”

Study limitations include heterogeneity of included studies: infrequent reporting of patient anticoagulation or antiplatelet status, comorbid conditions, index treatment, risk profiles for GI bleeding, and lack of generalizability of results outside of North America, where most included studies were conducted.