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. 2025 Sep;70(9):3089-3096.
doi: 10.1007/s10620-025-09116-6. Epub 2025 Jun 4.

Smoking and the Bleeding Gut: Impact on 30-Day Readmission with Recurrent Non-variceal Upper GI Hemorrhage

Dheeraj Alexander  1   2 , Mohamed Belal  3   4 , Mustafa Alnounou  5
Affiliations

Smoking and the Bleeding Gut: Impact on 30-Day Readmission with Recurrent Non-variceal Upper GI Hemorrhage

Dheeraj Alexander et al. Dig Dis Sci. 2025 Sep.

Abstract

Background and aims: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a frequent cause of hospitalization, with significant morbidity and healthcare costs. While non-endoscopic prognostic scores aid in assessing risk, limited data exist on factors influencing 30-day readmissions. Cigarette smoking has been implicated in various gastrointestinal (GI) disorders, yet its role in NVUGIB recurrence remains unclear.

Methods: We conducted a retrospective cohort study utilizing the 2021 Nationwide Readmission Database (NRD), analyzing patients with an index admission for NVUGIB. Patients were tracked for 30-day readmission due to recurrent GI bleeding. Cox regression models were employed to identify independent predictors of readmission, including cigarette smoking and other demographic, clinical, and hospital-level factors. The primary outcome was to analyze the effect of cigarette smoking on 30-day readmissions with recurrent upper GI bleeding. Secondary outcomes were readmission mortality rate, length of hospital stay, and total hospitalization charges.

Results: Out of 339,444 NVUGIB admissions, 14,247 (4.3%) resulted in 30-day readmission due to recurrent bleeding. In-hospital mortality among readmitted patients was 2.3%. The total length of hospital stay for all patients readmitted within 30 days of discharge was 68,869 days, with resulting total hospitalization charges of $874 million. Cigarette smoking was associated with an increased risk of 30-day readmission (Hazard ratio [HR]: 1.14, 95% CI 1.06-1.23, P = 0.001).

Conclusion: This study demonstrates that cigarette smoking is a significant modifiable risk factor for 30-day readmission due to recurrent NVUGIB. These findings underscore the need for targeted smoking cessation interventions to reduce readmission rates and healthcare resource utilization.

Keywords: Cigarette smoking; GI bleed; Non-variceal upper gastrointestinal bleeding; Readmission.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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