Timing of colonoscopy: Impact on length of hospital stay in patients with acute lower intestinal bleeding

OBJECTIVE: Previous studies suggest that urgent colonoscopic evaluation of massive lower intestinal bleeding (LIB) can reduce hospital length of stay (LOS). We sought to determine if time to colonoscopy impacts hospital LOS in patients admitted with all sources and severities of acute LIB. METHODS: A total of 252 consecutive patients admitted to a tertiary care hospital with acute LIB were identified. Cox proportional hazards regression was used to determine independent predictors of hospital LOS. Time from admission to colonoscopy was analyzed as a time-varying covariate. RESULTS: A total of 144 patients (57%) underwent an inpatient colonoscopy: 14 were done in <12 h, 55 in 12-24 h, 46 in 24-48 h, and 29 in >48 h. After controlling for the other independent correlates, earlier colonoscopy was significantly associated with a shorter hospital LOS (hazards ratio = 2.02, 95% CI = 1.5-2.6, p < 0.0001). The absence of visible blood or active bleeding at the time of colonoscopy was also independently related to a shorter hospital LOS (hazards ratio = 1.5, 95% = CI 1.1-2.0, p = 0.01). CONCLUSIONS: Time to colonoscopy is an independent predictor of hospital LOS. In a wide spectrum of patients with LIB, this reduction in hospital LOS seems to be primarily related to improved diagnostic yield rather than therapeutic interventions. (Am J Gastroenterol 2003;98:317-322. (C) 2003 by Am. Coll. of Gastroenterology).