Introduction Several medical conditions are associated with an increased mortality at the weekend. A UK prospective study of patients with upper gastrointestinal bleeding (UGIB) in 2011 showed no mortality difference between weekday and weekend admissions despite patients admitted at the weekend being more likely to be shocked, require blood and wait longer for endoscopy. A Welsh record linkage study examining 24, 421 admissions found that mortality was 13% higher for weekend and 41% higher for bank holiday admissions.
Method Using Hospital Episode Statistics (HES), we identified all patients admitted to hospital with UGIB between April 2001 and March 2014. Patients who underwent an in-patient endoscopy were analysed using multivariate regression analysis to explore the relationship between day of admission, age, ethnicity, comorbidity, diagnosis and length of time to endoscopy and mortality.
Results 885,572 UGIB admissions were identified with 421,726 of these (59% male, 41% female) resulting in an inpatient endoscopy. Patients admitted on a bank holiday had a higher risk of death within 30 days (OR 1.08, 95% CI 1.01–1.16, p 0.0231), as did patients admitted on a Sunday (1.10, 95% CI 1.07–1.13, p < 0.001). Females had a lower mortality when compared to male patients (0.95, 95% CI 0.93–0.97, p < 0.001). Those of a white/British ethnicity had a higher mortality when compared to those of an Asian (0.79, 95% CI 0.74–0.85, p < 0.001), Black (0.72, 95% CI 0.65–0.79, p < 0.001) or Chinese background (0.66, 95% CI 0.52–0.85, p = 0.001). Mortality increased with age with patients over 85 having the poorest prognosis. Increasing comorbidity was associated with increased risk of death with a Charlson score of 1–4 giving an OR of 1.18 (95% CI 1.13–1.22, p < 0.001) and a Charlson score of 5+ giving an OR of 2.80 (95% CI 2.73–2.86, p < 0.001). There was an increased 30-day mortality with varices (2.80, 95% CI 2.66–2.95, p < 0.001) and peptic ulcers (1.22, 95% CI 1.19–1.26, p < 0.001). Patients who underwent an endoscopy on the day of admission had an increased 30-day mortality (OR 1.42, 95% CI 1.38–1.46, p < 0.001) but the highest risk of death was in patients who waited 4 or more days for their endoscopy (OR 1.80, 95% CI 1.75–1.85, p < 0.001).
Conclusion There is a higher risk of death within 30 days if admitted on a Sunday or a bank holiday with UGIB. Predictably, older patients, males and those with more comorbidity had a poorer prognosis. Patients who undergo endoscopy on the day of admission have a higher mortality, probably because they are more unstable on admission.
Disclosure of interest None Declared.
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