Materials and methods

The Johns Hopkins Medicine IRB granted approval for this study with waived informed consent under protocol # NA_00078426. We performed a retrospective chart review of patients who were admitted as inpatients to Johns Hopkins Hospital (JHH) between November 2016 and February 2022 for GIB and declined ABT. Eligible patients were identified from our bloodless center’s database based on a primary diagnosis of GIB upon admission. Clinical data were subsequently retrieved from the patients’ electronic charts via Epic (Verona, WI). Patients included in the study were all inpatients of at least 18 years of age who presented with overt signs of GIB (e.g., melena, hematochezia, and hematemesis). Patients who were seen multiple times for GIB were counted as separate encounters if admissions were at least three weeks apart. Three patients had two separate encounters during the reviewed timeframe such that our study encompasses 27 unique patients, and 30 patient encounters. Patients who were initially admitted at external facilities for GIB, then transferred to JHH were excluded due to incomplete history of treatment and laboratory records prior to admittance at JHH.

Each patient was managed with a team of gastroenterologists, general surgeons, hematologists, and anesthesiologists who work together as a multidisciplinary team in the JHH Bloodless Medicine and Surgery program. Clinical decisions concerning surgical and medical interventions were made based on individual judgment of the medical team. The patient data examined included demographic factors like age, sex, BMI, baseline comorbidities, and anticoagulant usage. The elements of patient care and management that were analyzed were GIB type, therapeutic PBM interventions (e.g., iron, B12, folate, erythropoietin, and tranexamic acid), procedural or surgical interventions (e.g., endoscopy, colectomy), and clinical outcomes (e.g., length of stay, and mortality). Hemoglobin (Hb) concentrations are reported for the first, lowest (nadir) and last measurements before discharge.

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Statistical analysis was performed via JMP v12 (SAS Institutes, Cary, NC). Continuous variables were described using measures of central tendency and outlier limits. Based on a non-normal distribution of hemoglobin concentrations, this variable was primarily analyzed using median and interquartile range (IQR). Categorical variables were measured as percentages. Comparison of continuous variables were performed using Wilcoxon signed-rank test.

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