Delay in Post-Endoscopic Refeeding in Patients with Upper GI Bleeding Leads to Increased Hospital Length of Stay

Michael M Sutton; Mathew J Gregoski; Don C Rockey

doi:10.1016/j.amjms.2024.01.010

Delay in Post-Endoscopic Refeeding in Patients with Upper GI Bleeding Leads to Increased Hospital Length of Stay

Am J Med Sci. 2024 Jan 20:S0002-9629(24)00010-7. doi: 10.1016/j.amjms.2024.01.010. Online ahead of print.

Authors

Michael M Sutton¹, Mathew J Gregoski², Don C Rockey³

Affiliations

¹ Department of Internal Medicine, Department of Public Health Sciences, and Digestive Disease Research Center, Medical University of South Carolina, Charleston, S.C. USA.
² Department of Public Health Sciences, and Digestive Disease Research Center, Medical University of South Carolina, Charleston, S.C. USA.
³ Digestive Disease Research Center, Medical University of South Carolina, Charleston, S.C. USA.. Electronic address: rockey@musc.edu.

PMID: 38253257
DOI: 10.1016/j.amjms.2024.01.010

Abstract

Background: Patients with acute upper gastrointestinal bleeding (UGIB) are made NPO prior to endoscopy. It is standard practice in those found to have low risk lesions to immediately resume a usual diet. Here, we evaluated refeeding practices in hospitalized patients with UGIB after endoscopy.

Methods: In this retrospective single-center cross-sectional study, we examined patients over the age of 18 with acute UGIB and low risk or no endoscopic lesion(s). Appropriate refeeding was categorically defined as resuming normal diet ≤ 4 hours post-endoscopy.

Results: Of 230 patients (mean age, 62 years; 57% female) with acute UGIB and low-risk lesions or no lesion(s), 96 [41% (95% CI: 35% to 48%)] received their usual diet within 4 hours after EGD. For the remaining 134 patients, refeeding was delayed on average from 13 (NPO until regular diet) to 31 (NPO until liquid diet, then regular diet) hours. Baseline clinical features were identical in patients who received their regular diet within 4 hours after EGD and those who did not. Hospital length of stay was shorter in patients receiving usual diets promptly (5.3 days vs. 6.4 days, p = 0.03). Patients in an ICU at the time of their endoscopy had a statistically significantly higher probability of not being refed appropriately [OR 2.371, 95% CI 1.191-4.722).

Conclusions: Inappropriate dietary restrictions are frequent in patients with UGIB caused by low risk lesions. This delay in refeeding leads to increased length of hospital stay - suggesting that appropriate refeeding is an opportunity to improve patient care.

Keywords: care; hemorrhage; peptic; quality; ulcer.