Acute Gastrojejunal Ulcer With Hemorrhage: Nationwide Trends in Hospitalization, Demographic Disparity, Cost of Care, and Outcomes

Introduction: Complications at the gastrojejunal anastomosis after surgery can potentially be serious and even life threatening such as an acute gastrojejunal ulcer with hemorrhage (AGJUH). Limited epidemiological data exists on the number of hospitalizations, demographic variation, cost of care, comorbidity measures, and outcomes for AGJUH. Methods: We analyzed the National Inpatient Sample (NIS) database for all hospitalizations with AGJUH (ICD-9 code 534.00 and ICD-10 code K28.0 as applicable) as primary or secondary diagnosis during the period from 2012-2018. NIS is the largest all-payer inpatient care database in the United States. Statistical significance of variation in the number of hospitalizations, demographic disparity, cost of care, comorbidity measures, and outcomes during the study period were determined using Cochran-Armitage trend test. Results: Between 2012 and 2018, number of hospitalizations for AGJUH increased from 655 to 1,165 (p< 0.0001, Figure A). Hospitalizations with AGJUH were found to be more common in women (p=0.0001) and Caucasians (p=0.0008). Although age group 45-64 remained the most affected, age group 65-84 showed the greatest rise from 29.0% to 32.6% (p< 0.0001, Figure B). Generally, South remained the most affected region (p=0.01) throughout the study period. There was a significant rise in the Midwest from 13.7% to 20.6% (p=0.02) with a concurrent decrease in the Northeast from 29.0% to 20.2% (p=0.001). A proportional decrease in the number of hospitalizations was seen at both, urban non-teaching (38.2% to 22.3%, p< 0.0001, Figure C) and rural hospitals (9.2% to 7.7%, p=0.005, Figure C), while the number increased at urban teaching hospitals (52.7% to 70.0%, p< 0.0001, Figure C). Mean length of hospital stay for AGJUH decreased from 7.0 ± 0.8 to 6.2 ± 0.4 days (p=0.34). Overall mortality decreased from 2.3% to 1.7% (p=0.09, Figure D). Some of the most associated comorbid conditions with AGJUH were hypertension, fluid and electrolyte disorders, obesity, depression, and diabetes mellitus. Conclusion: A significant rise in the number of hospitalizations with AGJUH was found with interesting demographic variations and association with comorbidities. Decrease in length of hospital stays as well as overall mortality during the study period was likely due to increased use of newer, more advanced, diagnostic and treatment modalities. Further studies are needed to identify factors responsible for such trends to better elucidate our findings.Figure 1.: a) mortality rate, b) rate of refractory bleeding, c) rate of endoscopic intervention.