Observational Study
Copyright ©The Author(s) 2023.
World J Gastroenterol. Jan 28, 2023; 29(4): 744-757
Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.744
Table 1 Trends in discharges, hospital stay in days, and mortality for selected gastrointestinal diseases in California, 2018-2020
GI conditions
2018
2019
2020
Relative change
P for trend
Acute pancreatitis
Total number of discharges, n (%)26771 (0.8)26675 (0.8)23828 (0.8)-11.00.028
Total hospital stays (in thousands) days109.6107.699.4-9.30.118
Mortality, n (%)124 (0.5)134 (0.5)144 (0.6)16.10.029
Cholelithiasis
Total number of discharges39473 (1.2)39710 (1.3)33215 (1.2)-15.9< 0.001
Total hospital stays (in thousands) days129.1130.5107.4-16.80.152
Mortality, n (%)96 (0.2)94 (0.2)81 (0.2)-15.60.994
Diverticulitis
Total number of discharges16899 (0.5)16992 (0.5)13855 (0.5)-18.0< 0.001
Total hospital stays (in thousands) days75.776.061.5-18.80.495
Mortality, n (%)77 (0.5)67 (0.4)87 (0.6)13.00.042
Noninfectious gastroenteritis/colitis
Total number of discharges9376 (0.3)9236 (0.3)6734 (0.2)-28.2< 0.001
Total hospital stays (in thousands) days27.327.821.3-22.0< 0.001
Mortality, n (%)31 (0.3)35 (0.4)26 (0.4)-16.10.543
Nonvariceal upper GI bleeding
Total number of discharges32207 (1.0)33361 (1.1)29155 (1.0)-9.50.853
Total hospital stays (in thousands) days125.6132.6116.9-6.90.002
Mortality, n (%)581 (1.8)604 (1.8)623 (2.1)7.20.003
Variceal upper GI bleeding
Total number of discharges1007 (0.0)880 (0.0)808 (0.0)-19.80.006
Total hospital stays (in thousands) days4.03.73.2-20.00.635
Mortality, n (%)35 (3.5)38 (4.3)39 (4.8)11.40.149
Lower GI bleeding and diverticular bleeding
Total number of discharges11549 (0.4)11914 (0.4)10613 (0.4)-8.10.329
Total hospital stays (in thousands) days43.444.240.0-7.80.783
Mortality, n (%)132 (1.1)127 (1.1)100 (0.9)-24.20.145
Clostridium difficile
Total number of discharges1552 (0.0)1457 (0.0)963 (0.0)-38.0< 0.001
Total hospital stays (in thousands) days9.89.36.3-35.70.532
Mortality, n (%)17 (1.1)20 (1.4)15 (1.6)-11.80.308
Viral gastroenteritis
Total number of discharges6005 (0.2)5652 (0.2)3794 (0.1)-36.8< 0.001
Total hospital stays (in thousands) days17.016.011.6-31.8< 0.001
Mortality, n (%)15 (0.2)19 (0.3)18 (0.5)20.00.066
Crohn’s disease
Total number of discharges14273 (0.5)14510 (0.5)12583 (0.4)-11.80.021
Total hospital stays (in thousands) days76.677.570.1-8.50.060
Mortality, n (%)245 (1.7)242 (1.7)276 (2.2)12.70.004
Ulcerative colitis
Total number of discharges12805 (0.4)12919 (0.4)11848 (0.4)-7.50.132
Total hospital stays (in thousands) days74.775.570.5-5.60.361
GI: Gastrointestinal.
Table 2 2020 month-to-month disease-specific mortality trends, n (%)
January, 2020
February, 2020
March, 2020
April, 2020
May, 2020
June, 2020
July, 2020
August, 2020
September, 2020
October, 2020
November, 2020
December, 2020
Relative change
P for trend
Acute pancreatitis
Total number of discharges2163 (0.8)1935 (0.8)1956 (0.9)1642 (0.9)2002 (0.9)2092 (0.9)2063 (0.8)2077 (0.9)2106 (0.9)2096 (0.8)1913 (0.8)1783 (0.7)-17.6%< 0.0001
Mortality21 (1.0)12 (0.6)16 (0.8)8 (0.5)6 (0.3)12 (0.6)11 (0.5)14 (0.7)12 (0.6)8 (0.4)10 (0.5)14 (0.8)-33.3%0.211
Cholelithiasis
Total number of discharges3170 (1.1)2926 (1.1)2437 (1.1)2050 (1.1)2743 (1.2)2831 (1.2)2759 (1.1)2858 (1.2)3112 (1.3)3137 (1.3)2864 (1.2)2328 (1.0)-26.6%< 0.0001
Mortality6 (0.2)9 (0.3)2 (0.1)4 (0.2)7 (0.3)4 (0.1)3 (0.1)7 (0.2)14 (0.4)7 (0.2)8 (0.3)10 (0.4)66.7%0.060
Diverticulitis
Total number of discharges1349 (0.5)1315 (0.5)1067 (0.5)746 (0.4)1050 (0.5)1141 (0.5)1183 (0.5)1302 (0.5)1247 (0.5)1351 (0.5)1161 (0.5)943 (0.4)-30.1%0.0004
Mortality9 (0.7)11 (0.8)11 (1.0)6 (0.8)3 (0.3)3 (0.3)4 (0.3)9 (0.7)10 (0.8)7 (0.5)7(0.6)7 (0.7)-22.2%0.501
Noninfectious gastroenteritis/colitis
Total number of discharges720 (0.3)643 (0.3)538 (0.2)426 (0.2)539 (0.2)535 (0.2)554 (0.2)560 (0.2)641 (0.3)670 (0.3)510 (0.2)398 (0.2)-44.7%< 0.0001
Mortality2 (0.3)2 (0.3)3 (0.6)2 (0.5)2 (0.4)2 (0.4)3 (0.5)2 (0.4)2 (0.3)2 (0.3)1 (0.2)3 (0.8)50.0%0.859
Nonvariceal upper GI bleeding
Total number of discharges2971 (1.1)2692 (1.1)2458 (1.1)1960 (1.0)2361 (1.1)2440 (1.0)2451 (1.0)2325 (1.0)2428 (1.0)2396 (1.0)2450 (1.0)2223 (0.9)-25.2%<.0001
Mortality68 (2.3)61 (2.3)52 (2.1)55 (2.8)48 (2.0)40 (1.6)49 (2.0)35 (1.5)46 (1.9)47 (2.0)72 (2.9)50 (2.2)-26.5%0.882
Variceal upper GI bleeding
Total number of discharges80 (0.0)59 (0.0)71 (0.0)53 (0.0)55 (0.0)74 (0.0)65 (0.0)64 (0.0)73 (0.0)57 (0.0)74 (0.0)83 (0.0)3.8%0.042
Mortality2 (2.5)2 (3.4)1 (1.4)1 (1.9)1 (1.8)6 (8.1)5 (7.7)4 (6.3)6 (8.2)2 (3.5)2 (2.7)7 (8.4)250.0%0.050
Lower GI bleeding and diverticular bleeding
Total number of discharges1039 (0.4)943 (0.4)884 (0.4)743 (0.4)843 (0.4)834 (0.4)835 (0.3)906 (0.4)936 (0.4)916 (0.4)921 (0.4)813 (0.3)-21.80.231
Mortality13 (1.3)6 (0.6)12 (1.4)5 (0.7)9 (1.1)6 (0.7)7 (0.8)9 (1.0)7 (0.7)7 (0.8)8 (0.9)11 (1.4)-15.40.822
Clostridium difficile
Total number of discharges96 (0.0)98 (0.0)85 (0.0)63 (0.0)67 (0.0)81 (0.0)82 (0.0)80 (0.0)89 (0.0)95 (0.0)70 (0.0)57 (0.0)-40.60.131
Mortality2 (2.1)2 (2.0)4 (4.7)0 (0.0)0 (0.0)0 (0.0)2 (2.4)4 (5.0)0 (0.0)0 (0.0)1 (1.4)0 (0.0)-100.00.157
Viral gastroenteritis
Total number of discharges468 (0.2)395 (0.2)366 (0.2)248 (0.1)263 (0.1)296 (0.1)288 (0.1)325 (0.1)325 (0.1)327 (0.1)296 (0.1)197 (0.1)-57.9%0.536
Mortality4 (0.9)0 (0.0)2 (0.5)2 (0.8)2 (0.8)3 (1.0)0 (0.0)0 (0.0)2 (0.6)1 (0.3)2 (0.7)0 (0.0)-100.0%0.402
Crohn’s disease
Total number of discharges1262 (0.5)1137 (0.4)977 (0.4)817 (0.4)998 (0.5)997 (0.4)1076 (0.4)1102 (0.5)1120 (0.5)1078 (0.4)1040 (0.4)979 (0.4)-22.4%0.035
Mortality29 (2.3)26 (2.3)18 (1.8)25 (3.1)16 (1.6)25 (2.5)16 (1.5)20 (1.8)25 (2.2)22 (2.0)23 (2.2)31 (3.2)6.9%0.627
Ulcerative colitis
Total number of discharges1109 (0.4)1038 (0.4)917 (0.4)787 (0.4)953 (0.4)984 (0.4)1039 (0.4)973 (0.4)1068 (0.4)1081 (0.4)970 (0.4)929 (0.4)-16.2%0.0005
Mortality31 (2.8)32 (3.1)19 (2.1)28 (3.6)19 (2.0)23 (2.3)22 (2.1)23 (2.4)26 (2.4)27 (2.5)35 (3.6)46 (5.0)48.4%0.048
Acute cholangitis
Total number of discharges121 (0.0)107 (0.0)111 (0.0)74 (0.0)108 (0.0)103 (0.0)101 (0.0)126 (0.1)128 (0.1)161 (0.1)118 (0.0)108 (0.0)-10.7%0.032
Mortality1 (0.8)0 (0.0)0 (0.0)2 (2.7)0 (0.0)1 (1.0)1 (1.0)0 (0.0)1 (0.8)1 (0.6)0 (0.0)2 (1.9)100.0%0.671
GI: Gastrointestinal.
Table 3 Demographic and clinical characteristics of select gastrointestinal hospitalizations in California, 2018-2020, n (%)
Variables
2018
2019
2020
P value
Age, yr< 0.001
18-4447019 (27.7)46521 (27.2)40924 (28.1)
45-6456369 (33.2)5598 (32.7)46629 (32.0)
65-8451757 (30.5)53860 (31.5)45944 (31.6)
≥ 8514693 (8.7)14806 (8.6)12062 (8.3)
Sex< 0.001
Male78081 (46.0)78928 (46.1)68873 (47.3)
Female91745 (54.0)92239 (53.9)76677 (52.7)
Race< 0.001
White81404 (48.3)79531 (46.8)66613 (46.2)
African American13080 (7.8)13016 (7.7)11219 (7.8)
Hispanic53962 (32.0)55153 (32.5)47629 (33.0)
Asian Pacific Islander13422 (8.0)13894 (8.2)11375 (7.9)
Native American555 (0.3)835 (0.5)485 (0.3)
Other6286 (3.7)7336 (4.3)6947 (4.8)
Payer< 0.001
Medicare68639 (40.4)70861 (41.4)59701 (41.0)
Medicaid48581 (28.6)48048 (28.1)42046 (28.9)
Private45612 (26.9)44389 (25.9)37733 (25.9)
Self-pay3492 (2.1)3864 (2.3)2948 (2.0)
No charge204 (0.1)272 (0.2)170 (0.1)
Other3254 (1.9)3707 (2.2)2931 (2.0)
Elixhauser comorbidity index< 0.001
028927 (17.0)28648 (16.7)23244 (16.0)
131228 (18.4)31049 (18.1)26001 (17.9)
228036 (16.5)28078 (16.4)24118 (16.6)
≥ 381647 (48.1)83401 (48.7)72196 (49.6)
Bacterial pneumonia4232 (2.5)4285 (2.5)3856 (2.6)0.008
Bacterial pneumonia/respiratory failure specific mortality248 (0.1)271 (0.2)275 (0.2)0.009
Viral pneumonia76 (0.0)82 (0.0)724 (0.5)< 0.001
Viral pneumonia/respiratory failure specific mortality6 (0.0)5 (0.0)80 (0.1)< 0.001
COVID-19 specific mortality--123 (0.08)< 0.001
All-cause mortality1667 (1.0)1644 (1.0)1723 (1.2)< 0.001
COVID-19: Coronavirus disease 2019.
Table 4 Trends in discharges, mortality rate, and endoscopy utilization for gastrointestinal emergencies discharges in California, 2018-2020, n (%)
2018
2019
2020
Relative change
P for trend
ANVH (upper endoscopy)
Total number of discharges15310 (0.5)15942 (0.5)13622 (0.5)-11.0%0.121
Total hospital stays (in thousands) days65.069.260.2-7.4%0.002
Mortality321 (2.1)335 (2.1)346 (2.5)7.8%0.012
Procedure within 24 h5005 (32.7)5185 (32.5)4132 (30.3)-17.4%< 0.001
AVH (upper endoscopy)
Total number of discharges867 (0.0)744 (0.0)690 (0.0)-20.4%0.007
Total hospital stays (in thousands) days3.63.22.8-22.2%0.697
Mortality26 (3.0)22 (3.0)26 (3.8)0.0%0.414
Procedure within 24 h348 (40.1)327 (44.0)283 (41.0)-18.7%0.653
LGIB (lower endoscopy)
Total number of discharges5524 (0.2)5722 (0.2)4973 (0.2)-10.0%0.724
Total hospital stays (in thousands) days21.722.119.9-8.3%0.436
Mortality29 (0.5)35 (0.6)17 (0.3)-41.4%0.201
Procedure within 24 h859 (15.6)975 (17.0)793 (15.9)-7.7%0.534
Acute cholangitis (ERCP)
Total number of discharges1038 (0.0)962 (0.0)882 (0.0)-15.0%0.137
Total hospital stays (in thousands) days4.34.43.7-14.0%0.505
Mortality6 (0.6)4 (0.4)5 (0.6)-16.7%0.952
Procedure within 24 h268 (25.8)260 (27.0)220 (24.9)-17.9%0.695
Food impaction (EGD/upper endoscopy)
Total number of discharges127 (0.0)143 (0.0)118 (0.0)-7.1%0.834
Total hospital stays (in thousands) days0.60.60.60.0%0.849
Mortality4 (3.1)3 (2.1)0 (0.0)-100.0%0.086
Procedure within 24 h73 (57.5)70 (49.0)60 (50.8)-17.8%0.289
Foreign body (EGD)
Total number of discharges21 (0.0)17 (0.0)20 (0.0)-4.8%0.891
Mortality1 (4.8)2 (11.8)0 (0.0)-100.0%0.512
Procedure within 24 h7 (33.3)7 (41.2)12 (60.0)71.4%0.091
SBP-paracentesis
Total number of discharges3254 (0.1)3486 (0.1)3344 (0.1)2.8%< 0.001
Total hospital stays (in thousands) days32.435.333.84.3%0.594
Mortality621 (19.1)631 (18.1)592 (17.7)-4.7%0.147
Procedure within 24 h928 (28.5)1044 (30.0)1022 (30.6)10.1%0.065
ANVH: Acute nonvariceal hemorrhage; AVH: Acute viral hepatitis; LGIB: Lower gastrointestinal bleeding; ERCP: Endoscopic retrograde chol-angiopancreatography; EGD: Esophagogastroduodenoscopy; SBP: Spontaneous bacterial peritonitis.