Adekunle AD, Rubens M, Sedarous M, Tariq T, Okafor PN. Trends in gastrointestinal disease hospitalizations and outcomes during the first year of the coronavirus pandemic. World J Gastroenterol 2023; 29(4): 744-757 [PMID: 36742171 DOI: 10.3748/wjg.v29.i4.744]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 Processing time: 129 Days and 9.2 Hours
ARTICLE HIGHLIGHTS
Research background
Healthcare resource utilization declined during the coronavirus pandemic. How this impacted gastrointestinal (GI) disease hospitalizations is not fully understood. We sought to investigate trends in hospitalizations, inpatient endoscopy utilization and outcomes during the first year of the pandemic and lockdowns.
Research motivation
The need for a population level understanding of the impact of the coronavirus pandemic on the outcomes of patients hospitalized with GI diseases.
Research objectives
To investigate trends in hospitalizations, inpatient endoscopy utilization and outcomes during the first year of the pandemic and lockdowns.
Research 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, noninfectious gastroenteritis, upper and lower GI bleeding (LGIB), Clostridium difficile, viral gastroenteritis, inflammatory bowel disease, and acute cholangitis, using regression analyses. We also investigated endoscopy utilization for GI emergencies.
Research 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 compared to 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). Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB in which it was lower (P < 0.001).
Research conclusions
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.
Research perspectives
We observed that patients hospitalized with acute pancreatitis, diverticulitis, nonvariceal upper GI bleeding and Crohn’s disease experienced higher all-cause inpatient mortality during the pandemic. Further research is needed to elucidate the disease-specific and system-based risk factors for the increase in mortality observed in these conditions.
