Palliative care documentation in gastrointestinal bleeding hospitalizations: national trends and associated care patterns

Abstract

BACKGROUND: Gastrointestinal bleeding (GIB) often affects older, medically complex patients, yet national patterns of inpatient palliative care documentation in GIB are unknown. We aimed to characterize trends and factors associated with palliative care documentation and examine associated inpatient care and outcome patterns. METHODS: We conducted a retrospective serial cross-sectional study of adult principal-diagnosis upper or lower GIB hospitalizations in the 2016 to 2022 National Inpatient Sample. Documentation was defined by ICD-10-CM Z51.5 in any diagnosis field. Survey-weighted regression assessed associated factors and inpatient outcomes. RESULTS: Among 2,435,099 weighted hospitalizations, palliative care documentation was present in 65,675 (2.70%), increasing from 2.13% in 2016 to 3.43% in 2022. Associated factors included metastatic cancer (adjusted odds ratio [aOR], 8.276), age ≥85 years (aOR, 5.626), respiratory failure (aOR, 3.159), and dementia (aOR, 3.101). Relative to the White category, Black (aOR, 0.802) and Hispanic (aOR, 0.791) categories had lower adjusted odds. Documentation was associated with lower odds of endoscopy but higher odds of mechanical ventilation and renal replacement therapy. Among in-hospital decedents, coded do-not-resuscitate status was more frequent (80.2% vs 40.5%), and several treatments were less frequent. Adjusted length of stay and hospital charges were 4.3% and 1.1% higher, respectively. CONCLUSIONS: Palliative care documentation was uncommon and concentrated in higher-acuity hospitalizations. Because the code does not identify provider specialty, timing, or content, patterns are associations rather than effects and require validation in clinically richer data.