Abstract
Aims Acute lower gastrointestinal bleeding (ALGIB) is associated with significant clinical and economic burden. We evaluated factors correlating with prolonged hospital stay (PHS) in patients with ALGIB. Methods Retrospective study through electronic medical record review of patients with a final diagnosis of ALGIB, admitted between 1/2019-6/2022. Factors associated with PHS (>5 days) were determined by multivariate regression analysis. Results Overall, 160 patients were included (mean age: 75.8±13.3 years, 53.5% females, 29.4% receiving antiplatelets, 30% anticoagulants, 13.1% hemodynamically unstable at admission, 32.5% receiving blood transfusion). A total of 152 (95%) underwent endoscopy after a median of 1 day (range: 0-6) from admission: flexible sigmoidoscopy was the first-line investigation in 97 (60.6%) and total colonoscopy in 55 (34.4%). Endoscopic treatment was performed in 17.5%, 10.6% underwent CT angiography and 2.5% required embolisation or surgery. Diverticular bleeding (43.3%) was the most common cause of ALGIB. The median length of hospital stay was 5 days (range: 1-29), with PHS observed in 60 (38.2%). By multivariate analysis, hemodynamic instability at admission (OR=4.51, 95%CI:1.58-12.86; p=0.005) was the only significant predictor of PHS, whereas endoscopic hemostasis showed a non-significant inverse correlation (OR=0.40, 95%CI:0.14-1.10; p=0.07). Conclusions Massive hemorrhage with hemodynamic instability at admission appears to be the main determinant of PHS in patients with ALGIB. The impact of endoscopic treatment on the length of hospital stay warrants further investigation in larger studies. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany