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Mortality and Readmission Rates After Hospitalization for Upper and Lower Gastrointestinal Events in Quebec, Canada

Rahme, Elham PhD*,†; Roussy, Jean-Pascal BPharm, MSc; Woolcott, John PhD; Nedjar, Hacene MSc; Barkun, Alan MD, MSc*,†,§

Journal of Clinical Gastroenterology: August 2013 - Volume 47 - Issue 7 - p 586–592
doi: 10.1097/MCG.0b013e318282a1d7
ALIMENTARY TRACT: Original Articles

Goals: We determined yearly rates of upper and lower gastrointestinal (GI) hospitalizations in Quebec, Canada and compared the 1-year readmission and mortality risks among those discharged from lower versus upper GI hospitalizations.

Background: The burden of serious upper and lower GI events is substantial.

Study: Demographic, medical, pharmaceutical, and hospital records were used in a retrospective cohort study to assess risks of mortality and hospital readmission for upper and lower GI events among patients 50 years and older during 1998 to 2006.

Results: Among included 39,771 GI hospitalizations, 5238 were from 1998 to 1999, and 5050 from 2005 to 2006. Rates of upper GI hospitalizations decreased in the study period, whereas that of lower GI events did not change. The risk of in-hospital mortality was higher in patients with small bowel versus upper GI events [odds ratio 2.11; 95% confidence interval (CI), 1.81-2.47] and lower in patients with colon/rectal events 0.30 (0.25-0.36). One-year mortality risk after discharge was lower in patients with lower versus upper GI events (small bowel hazard ratio 0.81; 95% CI, 0.70-0.93; and colon/rectal: 0.77; 95% CI, 0.71-0.83). Compared to upper GI events, the risk of hospital readmission was higher in those with small bowel 1.53 (1.19-1.97) and similar in those with colon/rectal events 1.12 (0.96-1.31).

Conclusions: The risk of upper GI events may be decreasing, but remains over 3 times as high as that of lower GI events and among those admitted for GI events, about 80% of in-hospital mortality occurred in those with upper GI problems. Although GI events in the small bowel are less frequent than those in upper or lower GI tract, they are the most severe and are associated with higher risks of mortality and hospital readmissions.

*Department of Medicine

§Gastroenterology Unit, McGill University

Research Institute, McGill University Health Centre, Montreal

Health Economics & Outcomes Research, Pfizer Canada Inc., Kirkland, QC, Canada

E.R. is a research scholar funded by The Fonds de Recherche en Santé du Québec. She has received grants and/or consultant fees from Merck & Co. Inc., Pfizer Canada Inc., Boehringer Ingelheim, Chiesi Farmaceutici, Bayer and Ethypharm. J.-P.R. and J.W. are full-time employees of Pfizer Canada Inc. A.B. has received consultant fee from Pfizer Canada Inc. and from AstraZeneca Canada Inc.

This study was funded by Pfizer Canada Inc. The sponsor was involved in the determination of study objectives and interpretation of results but had no role in the design or conduct of the study. E.R. declares that she had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

All authors contributed to the writing, review, and approval of this manuscript.

Reprints: Elham Rahme, PhD, McGill University Health Centre, Division of Clinical Epidemiology, 687 Pine Avenue West, V Building. Montreal, QC, Canada H3A 1A1 (e-mail:

Received May 17, 2012

Accepted December 11, 2012

© 2013 by Lippincott Williams & Wilkins