Quality of Care in Peptic Ulcer Bleeding in a Large Cohort of Hospital Patients

As part of a large-scale effort to improve the quality of care delivered to patients with peptic ulcer bleeding, the authors of “Improving Quality of Care in Peptic Ulcer Bleeding: Nationwide Cohort Study of 13,498 Consecutive Patients in the Danish Clinical Register of Emergency Surgery,” published in The American Journal of Gastroenterology, looked at a large cohort of patients who were treated for peptic ulcer bleeding in Danish hospitals.

Describing the treatment of peptic ulcer bleeding as complex, and with a high rate of mortality, the researchers reviewed the demographic, clinical, and prognostic data collected by hospitals treating these patients, and evaluated the quality of care delivered using eight process and outcome indicators, including “time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.”

Of the nearly 13,500 patients studied (median age 74 years), one in four were classified as “in-hospital bleeders.” The researchers reported the following results:

• Preadmission use of anticoagulants, multiple coexisting diseases, and the American Society of Anesthesiologists scores increased between 2004 and 2011
• Considerable improvements were observed for most QOC indicators over time
• Endoscopic treatment was successful with primary hemostasis achieved in more patients (94% in 2010—2011 vs. 89% in 2004–2006)
• Endoscopy delay for hemodynamically unstable patients decreased during this period (43% vs. 34% had endoscopy within six hours)
• Fewer patients underwent open surgery (4% vs. 6%)
• Rebleeding rates improved (13% vs. 18%), after controlling for time changes in prognostic factors
• Crude 30-day mortality was unchanged (11% vs. 11%), whereas adjusted mortality decreased nonsignificantly over time

The authors concluded that quality of care in peptic ulcer bleeding has “improved substantially in Denmark, but the 30-day mortality remains high. Future initiatives to improve outcomes may include earlier endoscopy, having fully trained endoscopists on call, and increased focus on managing coexisting disease.”