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No change in patient outcomes for individuals admitted with upper gastrointestinal bleeding during the COVID-19 pandemic
Journal of Gastroenterology and Hepatology (Australia) ; 35(SUPPL 1):223, 2020.
Article in English | EMBASE | ID: covidwho-1109578
ABSTRACT
Background and

Aim:

The aerosol-generating nature of gastroscopy has prompted a revision of endoscopic standard operating procedures during the coronavirus disease 2019 (COVID-19) pandemic, the health impacts of which are yet to be determined. Patient outcomes may be affected by restricted endoscopic services (50% reduction in activity in Melbourne, Victoria, performing elective category 1 and 2p procedures only), patient COVID-19 health questionnaires and screening, staffing availability, personal protective equipment changes, and health care worker-perceived exposure risk. Additionally, public fear of transmission has led to a reduction in non-COVID-19-related hospital presentations.1 Furthermore, a recent study found that patients presenting with upper gastrointestinal bleeding (UGIB) during COVID-19 had higher rates of hypotension and anemia, higher transfusion requirements, longer hospital lengths of stay, and lower rates of gastroscopy.2 We aimed to evaluate the impact of COVID-19 on presentation and outcomes in patients with UGIB at a single tertiary center in Melbourne.

Methods:

We conducted a retrospective cohort study of adult patients who presented to our tertiary center with hematemesis and/or melena over the 11-week period from 1 April to 17 June 2020, during the first lockdown period in Melbourne, when there were significant restrictions to endoscopic services (COVID-19 group). Presenting symptoms, comorbidities, laboratory results, hemodynamics, severity scores (Rockall, AIMS65, and Glasgow-Blatchford scores), and patient outcomes were evaluated and compared with those for patients presenting with UGIB during the same period in 2019 (2019 group). Patient outcomes included time to endoscopy, endoscopy procedure duration, endoscopic findings, rebleeding rate, inpatient and 30-day mortality, intensive care unit (ICU) admission, hemodynamic nadir, and transfusion requirements.

Results:

A total of 27 patients were admitted with UGIB during the COVID-19 period, compared with 25 in the preceding year. Patients in the COVID-19 group were younger (P = 0.05), but baseline demographics, comorbidities, and anticoagulation use were otherwise similar between the two groups. Patients in the COVID-19 group were more likely to present with hematemesis (P < 0.01) and less likely to present with melena (P = 0.02). Platelet count and albumin levels were significantly lower in the COVID-19 group compared with the 2019 group (P = 0.05);laboratory results and hemodynamics were otherwise similar between the two groups at presentation. Rockall, AIMS65, and Glasgow-Blatchford scores were also similar. Both groups were equally likely to receive gastroscopy. Etiology of UGIB at endoscopy was similar. Transfusion requirement, nadir hemoglobin level, and rebleed rates were similar between the two groups, although a subgroup analysis of those swabbed for COVID-19 showed a greater reduction in hemoglobin level compared with the 2019 group (P = 0.03). There were no differences in ICU admissions, inpatient and 30-day mortality, or length of stay. There was a non-significant trend towards longer anesthetic preparation time for the COVID-19 group, but endoscopic procedure length was similar in the two groups. This was also similar in the subgroup analysis of the six patients who were swabbed for COVID-19 during their UGIB admission.

Conclusion:

Our study showed that patients were more likely to present with hematemesis than melena and that hemoglobin reduction was significantly greater during COVID-19 than in the preceding year. However, measures of severity at presentation, ICU admission, endoscopic findings, and patient outcomes, including timing to endoscopy, length of hospital stay, and mortality, were similar. Our data suggest that the imposed restrictions to endoscopic services and general public concerns about COVID-19 did not adversely affect patient outcomes during the first COVID-19 wave. This is in direct contrast to the findings of a study in New York City, an epicenter of the global COVID-19 pandemic, which reported signi icantly worse patient outcomes during COVID-19,2 and suggests that COVID-19 inpatient burden may be the primary driver accounting for these findings. At the time of writing, Melbourne is amid a second and far more serious wave of COVID-19, with more than six times the daily confirmed case rate necessitating a more stringent lockdown period. Data will be updated to include and contrast this second lockdown period and will be presented at Australian Gastroenterology Week.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of Gastroenterology and Hepatology (Australia) Year: 2020 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of Gastroenterology and Hepatology (Australia) Year: 2020 Document Type: Article