S810 Nonvariceal Upper Gastrointestinal Bleeding in Nonagenarians: Insights from the National Inpatient Sample

Introduction: Nonagenarians are expected to comprise 10% of the U.S. population by 2050. However, no studies have assessed the outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) in this age group. Methods: We conducted a retrospective cross-sectional study using the U.S. National Inpatient Sample (NIS) from 2016 to 2020. Our study included adult patients, 80 years or older, admitted with a principal diagnosis of NVUGIB. The clinical outcomes of NVUGIB in nonagenarians were compared to octogenarians using the Chi-squared test and Student's t-test. In addition, we evaluated the predictors of mortality and esophagogastroduodenoscopy (EGD) utilization using the multivariate logistic regression analysis. Results: The number of patients 80 years or older admitted with NVUGIB from 2016-2020 was 279,022, with 78,462 patients in the nonagenarians group and 200,560 in the octogenarians group. Nonagenarians had higher in-hospital mortality than octogenarians (4% vs. 3%, p < 0.0001), while the cost of hospitalization was lower in nonagenarians ($16,812 vs. $18,658, < 0.0001). There was a significantly lower rate of EGD utilization (30% vs. 48%, p < 0.001) and blood transfusion (27% vs. 40%, p < 0.0001) in nonagenarians. A higher proportion of nonagenarians had palliative care consults (5% vs. 4%, p < 0.0001) (Table 1). The multivariate logistic regression analysis showed that nonagenarians with NVUGIB had higher odds of mortality (OR 1.5, 95% CI 1.4-1.7) and lower odds of EGD utilization (OR 0.83, CI 0.79-0.86). In addition, the multivariate analysis showed lower EGD utilization in female elderly patients with NVUGIB (Figure 1). Conclusion: Nonagenarians admitted with NVUGIB are at a higher mortality risk than octogenarians. The lower rate of blood transfusion and EGD utilization, and the higher rate of palliative care consults in nonagenarians indicate that they are more likely to be managed conservatively. Nevertheless, a significant proportion of nonagenarians underwent EGD. More studies are needed to assess predictors of poor outcomes and the indications of EGD in this growing population.Figure 1.: Forest plot for multivariate logistic regression analysis for predictors of mortality (A) and EGD utilization (B). Table 1. - Baseline Characteristics and Clinical Outcomes of Octogenarians and Nonagenarians With Non-Variceal Upper Gastrointestinal Bleeding Octogenarians Nonagenarians P-value Patient baseline characteristics Number 200,560 78,462 Race, % < 0.0001 White 78 81 Black 9 7 Hispanic 7 6 Asian or Pacific Islander 4 4 Native American 0 0 Other 2 2 Indicator of sex, % < 0.0001 Male 46 38 Female 54 62 Charlson Comorbidity Index, % 0.000 0 5 4 1 18 14 2 19 15 3 58 67 Outcomes Died during hospitalization, % 3 4 < 0.0001 Length of stay, days 4.8 4.55 < 0.0001 Total cost of hospitalization $18658 $16812 < 0.0001 Acute kidney failure, % 29 21 < 0.0001 Acute respiratory failure, % 6 4 < 0.0001 Mechanical ventilation, % 4 2 < 0.0001 EGD, % 48 30 < 0.0001 Blood transfusion, % 40 27 < 0.0001 Palliative care consults, % 4 5 < 0.0001