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ORLANDO -- A lack of endoscopy services on the weekend may be linked to a significant increase in mortality in patients with non-variceal upper gastrointestinal hemorrhage, a researcher reported here.
According to a systematic review and meta-analysis of eight studies, weekend admission was associated with a significant increase in mortality in patients with non-variceal upper gastrointestinal hemorrhage (OR 1.12; 95% CI 1.07-1.16) but not in patients with variceal upper gastrointestinal hemorrhage, said Ashutosh Gupta, MD, of Medical Center Health System in Odessa, Texas, at .
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Known as the 'the weekend effect,' patients admitted to the hospital on weekends or holidays sometimes have worse outcomes -- potentially due to decreased staffing on weekends, delayed procedures, or because they are in critical condition.
"Weekend effect is a well known phenomenon," Gupta told 鶹ý. However, he noted that the discrepancies in research regarding outcomes inspired him to investigate further.
Gupta and colleagues searched Medline and Cochrane databases using keywords related to gastrointestinal hemorrhage and weekend effect. They identified 20 studies -- including five looking at variceal bleeding and eight with non-variceal bleeding -- totaling 592,2935 patients.
Primary outcome was mortality in patients with upper gastrointestinal hemorrhage who were hospitalized on the weekend or after-hours compared to a weekday, while secondary outcomes included need for definitive therapy and length of hospital stay. Weekend was defined as afternoon or midnight on Friday and ending midnight on Sunday or Monday morning.
The researchers found no overall association between weekend admission and mortality among patients with upper gastrointestinal hemorrhage. However, a meta-analysis of the eight studies that did not report having a weekend rounder showed a significant increase in mortality (OR 1.12; 95% CI 1.06-1.18).
Timing of endoscopy was also of significance, with six studies suggesting an association between weekend versus weekday endoscopy and mortality (OR 1.11; 95% CI 1.07-1.15).
"Timing of endoscopy is one of the most crucial things that may have made a difference in variceal bleeding," said Gupta.
Weekend effect on mortality was demonstrated in studies conducted in the U.S. (OR 1.10; 95% CI 1.06-1.15; N=4 studies) but not European or Asian studies. However, Gupta noted that the increase in reported mortality in the U.S. may be more related to database procedures than management skills.
The researchers found no significant association between weekend admission and endoscopic therapy, need for surgery or angiography, or length of hospital stay.
"Overall weekend coverage is very important and there is clearly discrepancy," concluded Gupta. "Our findings are relevant to policymakers and other stakeholders who should ensure the creation of consistent quality and access to care throughout the week."
He noted that the large patient population and subgroup analysis of type of bleeding, availability of weekend rounder, and geographic areas as leading study limitations. Other limitations included the observational nature of the studies and the use of large administrative databases which may have caused misclassification bias.
Disclosures
Gupta reported no financial disclosures of interest.
Primary Source
World Congress of Gastroenterology at ACG2017
Gupta A, et al "Weekend effect in patients with upper gastrointestinal hemorrhage: a systematic review and meta-analysis" ACG 2017; Oral Abstract 29.