J Gastroenterol Hepatol. 2023 Feb 20. doi: 10.1111/jgh.16153. Online ahead of print.
OBJECTIVES: Upper gastrointestinal bleeding (UGIB) is a common emergency, with high rates of hospitalization and in-patient mortality compared to other GI diseases. Despite readmission rates being a common quality metric, little data is available for UGIBs. This study aimed to determine readmission rates for patients discharged following an UGIB.
METHODS: Adhering to PRISMA guidelines, MEDLINE, Embase, CENTRAL, and Web of Science were searched to Oct 16th , 2021. Randomized and non-randomized studies which reported hospital readmission for patients following an UGIB were included. Abstract screening, data extraction and quality assessment were conducted in duplicate. A random-effects meta-analysis was performed, with statistical heterogeneity measured using I2 . The GRADE framework, with a modified Downs and Black tool, was used to determine certainty of evidence.
RESULTS: 70 studies were included of 1847 screened abstracted, with moderate interrater reliability. Within these studies, 4,292,714 patients were analyzed with a mean age of 66.6 years, and 54.7% male. UGIB had a 30-day all cause readmission rate of 17.4% (95%CI 16.7%-18.2%), stratification revealed a higher rate for variceal UGIB [19.6% (95%CI 17.6%-21.5%)] than non-variceal [16.8% (95% CI 16.0%-17.5%)]. Only one third were readmitted due to recurrent UGIB (4.8% [95%CI 3.1%-6.4%]). UGIB due to peptic ulcer bleeding had the lowest 30-day readmission rate [6.9%(95%CI 3.8%-10.0%)]. Certainty of evidence was low or very low for all outcomes.
CONCLUSIONS: Almost one in five patients discharged after an UGIB are readmitted within thirty days. This data should prompt clinicians to reflect on their own practice to identify areas of strength or improvement.