Factors influencing the duration of Hospital stay in patients with acute lower gastrointestinal bleeding: a single Tunisian center experience

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Aims Acute lower gastrointestinal bleeding (ALGIB) presents significant clinical and economic challenges, often requiring prolonged hospitalization. Identifying factors contributing to prolonged hospital stays (PHS) in patients with ALGIB is essential for optimizing patient care and resource management. This study investigates the key determinants associated with extended hospitalization in ALGIB patients. Methods This is a retrospective study, conducted between January 2022 and October 2024 at a tertiary university hospital, and including all patients with ALGIB. Factors associated with prolonged hospital stay (PHS, defined as>5 days) were evaluated using multivariate regression analysis. Results A total of 109 consecutive patients were included in the study, with a median age of 72.5 years (range 22–91). Of these, 52 patients (47.7%) were over 70 years old, and 92 patients (84.4%) were men, resulting in a male-to-female sex ratio of 5.4. Hypertension was the most common comorbidity, present in 82 patients (75.2%), followed by diabetes in 56 patients (51.4%). Additionally, 25 patients (22.9%) were receiving antiplatelets, 18 patients (16.5%) were on anticoagulants, and 18 patients (16.5%) were hemodynamically unstable at admission. Diverticular bleeding was the most common source of bleeding, accounting for 54.1% of cases. Six patients (5.5%) died, while 22 patients (20.2%) experienced recurrent bleeding. Furthermore, 68 patients (62.4%) required transfusions, 12 patients (11%) received endoscopic therapy, and one patient (0.9%) underwent transcatheter arterial embolization. A total of 102 patients (93.5%) underwent endoscopy after a median of 1 day (range: 1–6) from admission, with flexible sigmoidoscopy being the first-line investigation in 100 patients (98%). CT angiography was performed in 10 patients (9.2%). The median length of hospital stay was 5 days (range: 1–31), with prolonged hospital stays (PHS) observed in 87 patients (79.8%). Univariate analysis revealed that age (p=0.03), comorbidities (p=0.03), use of antiplatelet or anticoagulant therapy (p=0.04), and hemodynamic instability at admission (p=0.01) were associated with PHS. Multivariate analysis identified hemodynamic instability at admission as the only significant predictor of PHS (OR=4.48, 95% CI: 1.56–10.76; p=0.002). Conclusions Hemodynamic instability at admission is a significant predictor of prolonged hospital stay in patients with acute lower gastrointestinal bleeding. This finding highlights the importance of early recognition and management of hemodynamic instability to potentially reduce the duration of hospitalization and improve patient outcomes. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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