Division of Hospital Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
Department of Medicine, North Shore Medical Center, Salem, MA, USA.
Dig Dis Sci. 2019 Sep;64(9):2467-2477. doi: 10.1007/s10620-019-05598-3. Epub 2019 Mar 30.
Providing diagnostic and therapeutic interventions, lower gastrointestinal endoscopy is a salient investigative modality for ischemic bowel disease (IB). As studies on the role of endoscopic timing on the outcomes of IB are lacking, we sought to clarify this association.
After identifying 18-to-90-year-old patients with a primary diagnosis of IB from the 2012-2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we grouped them based on timing of endoscopy into three: early (n = 9268), late (n = 3515), and no endoscopy (n = 18,452). We explored the determinants of receiving early endoscopy, the impact of endoscopic timing on outcomes (mortality and 13 others), and the impact of the type of endoscopy (colonoscopy vs. sigmoidoscopy) on these outcomes among the early group (SAS 9.4).
Less likely to receive early endoscopy were Blacks compared to Whites (adjusted odds ratio [aOR] 0.81 95% CI [0.70-0.94]), and individuals on Medicaid, Medicare, and uninsured compared to the privately insured group (aOR 0.80 [0.71-0.91], 0.70 [0.58-0.84], and 0.68 [0.56-0.83]). Compared to the late and no endoscopy groups, patients with early endoscopy had less mortality (aOR 0.53 [0.35-0.80] and 0.09 [0.07-0.12]), shorter length of stay (LOS, 4.64 [4.43-4.87] days vs. 8.87 [8.40-9.37] and 6.62 [6.52-7.13] days), lower total hospital cost (THC, $41,055 [$37,995-$44,361] vs. $72,598 [$66,768-$78,937] and $68,737 [$64,028-$73,793]), and better outcomes. Similarly, among those who received early endoscopy, colonoscopy had better outcomes than sigmoidoscopy for mortality, THC, LOS, and adverse events.
Early endoscopy, especially colonoscopy, is associated with better clinical outcomes and decreased healthcare utilization in IB. Unfortunately, there are disparities against Blacks, and non-privately insured individuals in receiving early endoscopy.
下消化道内镜检查为缺血性肠病（IB）提供了诊断和治疗干预，是一种重要的检查方法。由于缺乏关于内镜检查时机对 IB 结果影响的研究，我们旨在阐明这种关联。
从 2012-2014 年医疗保健成本和利用项目-全国住院患者样本中确定了年龄在 18 至 90 岁之间的原发性 IB 患者，根据内镜检查的时间将他们分为三组：早期（n=9268）、晚期（n=3515）和无内镜检查（n=18452）。我们探讨了接受早期内镜检查的决定因素，内镜检查时机对结果（死亡率和其他 13 项）的影响，以及早期组中结肠镜与乙状结肠镜检查对这些结果的影响（SAS 9.4）。
与白人相比，黑人接受早期内镜检查的可能性较小（校正优势比[OR]0.81，95%置信区间[0.70-0.94]），与私人保险组相比，接受医疗补助、医疗保险和无保险的个体接受早期内镜检查的可能性较小（OR 0.80 [0.71-0.91]，0.70 [0.58-0.84]和 0.68 [0.56-0.83]）。与晚期和无内镜检查组相比，早期内镜检查患者的死亡率较低（OR 0.53 [0.35-0.80]和 0.09 [0.07-0.12]），住院时间较短（4.64 [4.43-4.87]天 vs. 8.87 [8.40-9.37]和 6.62 [6.52-7.13]天），总住院费用较低（$41055 [$37995-$44361] vs. $72598 [$66768-$78937]和 $68737 [$64028-$73793]），结果更好。同样，在接受早期内镜检查的患者中，与乙状结肠镜检查相比，结肠镜检查在死亡率、总住院费用、住院时间和不良事件方面的结果更好。
早期内镜检查，特别是结肠镜检查，与 IB 的临床结果改善和医疗保健利用减少有关。不幸的是，黑人以及非私人保险的个体在接受早期内镜检查方面存在差异。
