Outpatient management of upper digestive hemorrhage not associated with portal hypertension: A large prospective cohort

OBJECTIVES: To evaluate the safety of outpatient management of upper GI hem orrhage (UGIH) not associated with portal hypertension. METHODS: A prospective cohort of 983 subjects who went to the Accident & Em ergency Department (A&ED) of a University hospital in Valencia (Spain), for UGIH not associated with portal hypertension during 1994 to 1997 were eval uated. After evaluation in the A&ED, 216 patients (22%) were discharged and referred for outpatient followup, but 15 patients could not be located thu s, reducing the follow-up to 201 subjects. The main outcome measures were r ebleeding within 10 days, emergency surgery within 15 days, and mortality f or any cause during the 30 days after the initial hemorrhaging episode. RESULTS: UGIH in subjects under outpatient care were less severe than those subjects in the hospitalized group. Hemorrhaging recurred in 7.3% of inpat ients versus 0.5% of outpatients (p < 0.01); emergency surgery was required in 5.6% of the hospitalized patients and 0.5% of the outpatients (p < 0.01 ); a total of 20 deaths occurred in the hospitalized group (2.6%), while th ree (1.5%) occurred in outpatients (p = 0.26). After adjusting for several significant risk factors, outpatient management was not associated with out comes that were worse. CONCLUSIONS: Treatment under an outpatient regime is a safe alternative for a large percentage of selected patients with UGIH not associated with port al hypertension, (C) 2001 by Am. Coll. of Gastroenterology.