Introduction:

Upper GI bleeding is the most common gastrointestinal emergency. Studies have established the presence of a gender gap in the treatment outcomes of multiple medical conditions. Few small studies reached conflicting results on this topic among patients with peptic ulcer bleeding. We sought to answer this important question using national databases.

Methods:
This is a retrospective cohort study using the National Inpatient Database (NIS) and the National Emergency Department (ED) Sample (NEDS) 2019. Admissions with a principal diagnosis of peptic ulcer bleeding were included. Exclusion criteria were age less than 18 years and elective admissions. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were 1-treatment modalities: upper endoscopy (EGD), endoscopic, radiologic and surgical therapy, 2-morbidity: hypovolemic shock, 3- resource utilization: length of stay, total hospitalization costs and charges. Multivariate linear or logistic regression were used to adjust for multiple patient and hospital confounders (listed in Table1).

Results:
There were 132,276 ED visits for ulcer bleeding in 2019, 134,733 (46.3%) of whom were female. 91.7% of female patients were admitted. The mean age was 68 (67 - 69) years. An EGD was performed in 91% of admissions (1 EGD: 64%, 2 EGDs: 20%, 3 or more EGDs: 7%), 69% of which were within 24 hours of admission. The rate of endoscopic, radiologic and surgical therapy was 28.5%, 1.2% and 0.1%, respectively. The endoscopic therapy success rate was 95%. Hypovolemic shock occurred during 3.5% of admissions. The in-hospital all-cause mortality rate was 1.9%. Table 1 presents adjusted odds ratios and mean differences. When compared to men, women had similar odds of in-hospital mortality. However, they had lower adjusted odds of an in-hospital EGD, early EGD, and endoscopic and radiologic therapy, with similar adjusted odds of surgery. Female patients also had lower adjusted total hospitalization costs and charges despite similar adjusted length of stay.

Conclusion:

We measured important treatment outcomes among female patients with ulcer bleeding in the United States. Although a gender gap is not observed for in-hospital mortality, women are less likely to receive both an in-hospital endoscopy and endoscopic or radiologic therapy. Resource utilization is also lower than that of men in this setting despite similar disease severity and length of stay

Ahmet Yildirim

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