Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2023; 29(4): 744-757
Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.744
Trends in gastrointestinal disease hospitalizations and outcomes during the first year of the coronavirus pandemic
Ayooluwatomiwa Deborah Adekunle, Muni Rubens, Mary Sedarous, Tahniyat Tariq, Philip N Okafor
Ayooluwatomiwa Deborah Adekunle, Division of Internal Medicine, St. Luke's Hospital, Chesterfield, MI 63017, United States
Muni Rubens, Office of Clinical Research, Miami Cancer Institute, Miami, FL 33176, United States
Mary Sedarous, Division of Internal Medicine, McMaster University, Hamilton ON L8S 4L8, Ontario, Canada
Tahniyat Tariq, Division of Gastroenterology, Stanford University School of Medicine, Redwood City, CA 94063, United States
Philip N Okafor, Division of Gastroenterology, Stanford University College of Medicine, Redwood City, CA 94063, United States
Author contributions: Okafor PN and Adekunle AD conceived and designed the study; Rubens M performed the statistical analysis; Adekunle AD, Rubens M, Sedarous M, and Okafor PN wrote and critically reviewed the manuscript; all authors reviewed and approved the manuscript.
Institutional review board statement: Based on the determination that this study did not meet the Department of Health and Human Services definition of human subject research, this study was considered exempt by the Stanford University Institutional Review Board.
Informed consent statement: Informed consent not applicable for our study because it utilized publicly available, de-identified administrative data.
Conflict-of-interest statement: The authors have no relevant conflict of interest to disclose.
Data sharing statement: Data for this study are available publicly and can be purchased through the HCUP Central Distributor.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Philip N Okafor, FACG, MD, Doctor, Division of Gastroenterology, Stanford University College of Medicine, 420 Broadway Street, Pavilion D, 2nd Floor, Redwood City, CA 94063, United States. philokafor@gmail.com
Received: September 13, 2022
Peer-review started: September 13, 2022
First decision: October 19, 2022
Revised: November 5, 2022
Accepted: November 28, 2022
Article in press: November 28, 2022
Published online: January 28, 2023
Abstract
BACKGROUND

The impact of the coronavirus on hospitalizations for gastrointestinal (GI) disease, particularly at a population level is understudied.

AIM

To investigate trends in hospitalizations, inpatient endoscopy resource utilization, and outcomes during the first year of the coronavirus pandemic and subsequent lockdowns.

METHODS

Using the California State Inpatient Database for 2018-2020, we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality (all-cause & viral pneumonia-specific) for common inpatient GI diagnoses including acute pancreatitis, diverticulitis, cholelithiasis, non-infectious gastroenteritis, upper and lower GI bleeding (LGIB), Clostridium difficile, viral gastroenteritis, inflammatory bowel disease, and acute cholangitis.

RESULTS

Disease-specific hospitalizations decreased for all included conditions except nonvariceal upper GI bleeding (NVUGIB), LGIB, and ulcerative colitis (UC) (ptrend < 0.0001). All-cause inpatient mortality was higher in 2020 vs 2019, for acute pancreatitis (P = 0.029), diverticulitis (P = 0.04), NVUGIB (P = 0.003), and Crohn’s disease (P = 0.004). In 2020, hospitalization rates were lowest in April, November, and December. There was no significant corresponding increase in inpatient mortality except in UC (ptrend = 0.048). Viral pneumonia and viral pneumonia complicated by respiratory failure increased (P < 0.001) among GI hospitalizations. Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB (P < 0.001).

CONCLUSION

Our findings suggest that hospitalization rates for common GI conditions significantly declined in California during the COVID pandemic, particularly in April, November and December 2020. All-cause mortality was significantly higher among acute pancreatitis, diverticulitis, NVUGIB, and Crohn’s disease hospitalizations. Emergency endoscopy rates were mostly comparable between 2020 and 2019.

Keywords: COVID-19, Shelter-in-place, Procedure utilization, Outcomes, Hospitalizations, Gastrointestinal diseases

Core Tip: In the current study, we found that, in the first year of the pandemic (2020), the lowest hospitalization rates for common gastrointestinal (GI) conditions in California coincided with peaks of the pandemic in April, November, and December. Overall, there was a 15% hospitalization rate reduction for acute GI conditions in 2020 (the first year of the pandemic) compared to 2019. No significant increase in all-cause mortality for GI admissions was observed for any of the conditions studied except acute pancreatitis, diverticulitis, nonvariceal upper GI bleeding (NVUGIB) and Crohn’s disease. Emergency endoscopies within the first 24 h for acute GI conditions in 2020 were comparable with previous years except for NVUGIB. Unfortunately, there was a corresponding increase in all-cause mortality for NVUGIB. We also outline and create plots of the number of admissions and associated in patient all-cause mortality by month of the year for the conditions studied.