番茄社区

VANCOUVER, British Columbia -- A significant proportion of very elderly people admitted for upper gastrointestinal bleeds underwent esophagogastroduodenoscopy (EGD), with mortality significantly higher in the oldest patients, a retrospective analysis of the National Inpatient Sample (NIS) found.

The dataset examined adults 80 and older with non-variceal upper gastrointestinal bleeding (NVUGIB), finding that 30% of the nonagenarians got EGD, Khaled Elfert, MD, of the St. Barnabas Health System in New York City, reported here.

"This is a good percentage when you consider their age group," he told 番茄社区 at the American College of Gastroenterology annual meeting.

Nonagenarians admitted with NVUGIB were found to be at higher in-hospital mortality risk compared with octogenarians (4% vs 3%, P<0.0001). Among the 80-year-olds, 48% underwent EGD.

Limited if any data in the literature exist on EGD outcomes in this patients 90 and over, said Elfert.

The present study examined 200,560 individuals ages 80 and older with NVUGIB (39% of whom in their 90s) in the NIS from 2016 to 2020.

Upper GI bleeding in the patient population was due to gastric ulcers, duodenal ulcers, or esophagitis, Elfert stated. The majority of all study patients were white. More of the nonagenarians had a Charlson Comorbidity Index of 3 (67% vs 58%). There were more women among the 90-year-olds versus the 80-year-olds (62% vs 56%). Multivariate analysis showed lower EGD utilization in female elderly patients with NVUGIB.

For patients in their 90s versus those in their 80s, respectively, the study also found (P<0.0001 for all):

• Lower hospitalization costs: $16,812 vs $18,658
• Shorter length of stay: 4.55 vs 4.8 days
• Lower rate of blood transfusion: 27% vs 40%
• More palliative care consults: 5% vs 4%

"The lower rate of blood transfusion and EGD utilization, and the higher rate of palliative consults, in nonagenarians indicate that they are more likely to be treated conservatively," Elfert said. "Nevertheless, a significant proportion of the nonagenarians underwent EGD."

As for the abbreviated length of stay, it may have been influenced by the higher in-hospital mortality for the very elderly patients, he said. The younger patients had higher percentages of acute kidney failure and acute respiratory failure, as well as greater need for mechanical ventilation than the older group, Elfert stated.

Vikash Kumar, MD, of the Brooklyn Hospital Center in New York City, told 番茄社区 that when he sees a patient in their 90s, "I evaluate them for EGD based on their functionality. If someone has dementia or is bed-bound, at that point, I have a discussion with the family."

"But if someone is still good in their 90s, then for sure, we would consider doing the endoscopy," said Kumar, who was not involved in the study.

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