Original article—alimentary tract
Outcomes of Weekend Admissions for Upper Gastrointestinal Hemorrhage: A Nationwide Analysis

https://doi.org/10.1016/j.cgh.2008.08.013Get rights and content

Background & Aims

Previous studies have identified a weekend effect in outcomes of patients with various medical conditions suggesting worse outcomes for weekend admissions. The aim of our study was to analyze if weekend admissions for upper gastrointestinal hemorrhage (UGIH) have higher mortality and longer hospital stay compared with those admitted on weekdays, and to examine if this effect differs by hospital teaching status.

Methods

This was a cross-sectional study using the Nationwide Inpatient Sample 2004. A total of 28,820 discharges with acute variceal hemorrhage (AVH) and 391,119 discharges with acute nonvariceal UGIH (NVUGIH) were identified through appropriate International Classification of Diseases, ninth edition codes. Admissions were considered to be weekend admissions if they were admitted between midnight on Friday through midnight on Sunday. In-hospital mortality, frequency, and timing of endoscopy were measured.

Results

On multivariate analysis, NVUGIH patients admitted on weekends had higher adjusted in-hospital mortality (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.09–1.35) and were less likely to undergo early endoscopy within 1 day of hospitalization (OR, 0.64; 95% CI, 0.61–0.68). Weekend admission was not predictive of in-hospital mortality in patients with AVH (OR, 0.94; 95% CI, 0.75–1.18), but was associated with lower likelihood of early endoscopy in nonteaching hospitals (OR, 0.65; 95% CI, 0.51–0.82). Early endoscopy was associated with significantly shorter hospital stays (NVUGIH, −1.08 days; AVH, −2.35 days) and lower hospitalization charges (NVUGIH, −$1958; AVH, −$8870).

Conclusions

Patients with NVUGIH admitted on the weekend had higher mortality and lower rates of early endoscopy. Patient with AVH admitted to nonteaching hospitals also had lower utilization of early endoscopy, but no difference in survival. There is a need for research into identifying the reasons for the weekend effect.

Section snippets

Data Source

We used data from the Nationwide Inpatient Sample (NIS) for the year 2004.17 This is the largest all-payer inpatient database in the United States and is part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.18 The NIS contains information on nearly 8 million discharges from a 20% stratified sample of hospitals across 37 participating states, with the stratification based on hospital teaching status, number of beds, location, ownership, and

Acute Nonvariceal Upper Gastrointestinal Hemorrhage

There were 80,661 actual discharges that fit the case definition for NVUGIH in the NIS 2004 database. This yielded an adjusted national estimate of 301,357 hospitalizations related to NVUGIH admitted on a weekday and 89,762 hospitalizations admitted on one of the weekend days (23.0%) (total adjusted national estimate for all NVUGIH hospitalizations = 391,119). There were clinically small, but statistically significant, differences in demographic characteristics between weekday and weekend

Discussion

Previous studies have shown differences in outcomes between weekend and weekday admissions.1, 2, 4, 8, 10 However, there has been limited analysis focusing on patients with UGIH, a common medical emergency that carries significant morbidity and mortality. We examined the impact of weekend hospitalization for patients with UGIH and show the following: (1) NVUGIH patients admitted on weekends have a higher adjusted mortality and are less likely to undergo early endoscopy during their

Acknowledgements

This work was presented in part as an oral presentation at Digestive Disease Week, San Diego, California, May 17–22, 2008.

References (38)

  • R.A. Deyo et al.

    Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

    J Clin Epidemiol

    (1992)
  • M.E. Charlson et al.

    A new method of classifying prognostic comorbidity in longitudinal studies: development and validation

    J Chronic Dis

    (1987)
  • D.M. Quirk et al.

    Physician specialty and variations in the cost of treating patients with acute upper gastrointestinal bleeding

    Gastroenterology

    (1997)
  • D.J. Bjorkman et al.

    Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study

    Gastrointest Endosc

    (2004)
  • G.S. Cooper et al.

    Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay

    Gastrointest Endosc

    (1999)
  • D. Sorbi et al.

    An assessment of the management of acute bleeding varices: a multicenter prospective member-based study

    Am J Gastroenterol

    (2003)
  • A. Zaman et al.

    Bleeding caused by portal hypertension

    Gastroenterol Clin North Am

    (2005)
  • Y. Arias et al.

    Association between evening admissions and higher mortality rates in the pediatric intensive care unit

    Pediatrics

    (2004)
  • D.J. Becker

    Do hospitals provide lower quality care on weekends?

    Health Serv Res

    (2007)
  • Cited by (142)

    • The weekday effect on postoperative mortality in elective abdominal surgery: An observational study using propensity score methods

      2021, Surgery (United States)
      Citation Excerpt :

      Several studies have shown that reduced staffing levels during the weekend may be a factor for the higher mortality in patients operated or admitted on a weekend.2,3 Other reports have found that increased mortality is related to the decreased availability of therapeutic and diagnostic services, such as endoscopies for emergency gastrointestinal bleeding.22−27 Similarly, there are also some differences in resources available in the weekend compared with those on a weekday at our center.

    • There Is No Weekend Effect in the Trauma Patient

      2021, Journal of Surgical Research
      Citation Excerpt :

      The presence of a “weekend effect,” in which patients admitted to the hospital during the weekend have increased morbidity and/or mortality compared with those admitted during the week, has been reported in numerous studies in a variety of conditions1-4 and countries.5-9

    • Analysis of weekend effect on mortality by medical specialty in Helsinki University Hospital over a 14-year period

      2020, Health Policy
      Citation Excerpt :

      The weekend effect, the phenomenon of patients admitted at the weekend having a higher mortality risk, has been widely investigated [1]. Evidence has been found for [2–10] and against [2,11] disease-specific weekend effects, with conflicting results for stroke [12–15], acute myocardial infarction (AMI) [16–19], and hip fracture [20–22]. In previous studies, systematic reviews and meta-analyses, emergency patients admitted at the weekend suffered higher in-hospital mortality across both medical and surgical diagnoses [23–27], with a larger risk in major teaching hospitals [28,29], with varying specialty-specific [30–36] and disease-specific [26,37–40] results.

    • Outcomes in lower GI bleeding comparing weekend with weekday admission

      2020, Gastrointestinal Endoscopy
      Citation Excerpt :

      Secondarily, we excluded all patients admitted with a primary diagnosis of anemia and a secondary diagnosis of an upper GI or small- bowel cause (Supplementary Table 2, available online at www.giejournal.org). Weekend admissions were determined using the standard NIS definitions, which included any patient admitted from 12:00 am Saturday to 11:59 pm Sunday, as has been used in multiple previous studies of the weekend effect.6,7,10-13 Mortality was defined as in-hospital mortality from any cause.

    View all citing articles on Scopus

    Conflicts of interest The authors disclose no conflicts.

    View full text