Gastrointestinal bleeding (GIB) remains one of the leading causes of emergency hospital admission for gastrointestinal disorders and continues to represent a major source of morbidity and mortality. Its burden is particularly relevant in aging populations, where widespread use of antithrombotic and anticoagulant agents increases bleeding risk. We aimed to conduct a comprehensive, methodologically consistent, population-based analysis of GIB in hospital-mortality in the Veneto Region (Northeastern Italy) over a 25-year period.

A retrospective analysis based on the anonymous regional Hospital Discharge Records database was carried out including all discharges from hospitals operating under the National Health Service in the Veneto Region in the period 2000-2024 with a Diagnosis-Related Group (DRG) code equal to 174 (“Gastrointestinal Haemorrhage with Complications”) or 175 (“Gastrointestinal Haemorrhage without Complications”), or any surgical DRG with a principal discharge diagnosis indicative of GIB. Moreover, selected cases were stratified into upper, lower or unspecified GIB, based on the site of bleeding. Crude in-hospital Case-Fatality Risks (CFR) were calculated among all GIB patients and expressed per 100 patients. Annual trends were analysed in terms of Annual Percentage Change (APC) and Average Annual Percent Change (AAPC).

During the 25-year observation period, 99,731 patients were hospitalized for GIB in the Veneto Region. Upper, lower, and unspecified GIB accounted for 46.6%, 39.5%, and 13.9% of cases, respectively. The mean age of patients was 70.6±18.1 years. Males represented 55.2% of all GIB cases and were significantly younger than females (67.0±18.2 vs. 75.1±16.9 years, respectively; p<0.001). 

Crude in-hospital CFR for GIB was 5.0% during the 25-year observation period and it was higher in females than in males (5.6% vs 4.5%; crude OR 1.26; 95% CI 1.19 to 1.33). It was 2-fold higher in unspecified GIB (8.8%) than in upper GIB and lower GIB (4.4% each). Overall, CFR decreased from 5.4% in 2000 to 4.4% in 2018 (APC -0.71%, 95% CI −4.29 to +0.06, p=0.056) but increased again in the latest years of the study (APC+3.42%, 95% CI −0.14 to +14.15, p=0.062), peaking at 5.9% in 2021. Considering the 25-year period, only unspecified GIB showed a significantly decreasing trend in the crude in-hospital CFR (AAPC -1.31%, 95% CI −2.55 to −0.27, p=0.019).

Despite an aging population and a progressive shift toward outpatient management of low-risk cases, the crude in-hospital CFR showed only a slight reduction in the Veneto Region from 2000 to 2024.