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Effect of Weekend Hospital Admission on Gastrointestinal Hemorrhage Outcomes

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Abstract

Objective

To determine whether outcomes for patients admitted with UGIH differ depending on weekend versus weekday admission, and whether any such differences are mediated by discrepancies in the use and timing of endoscopy.

Methods

This was a cross-sectional comparison of mortality, resource use, and the utilization and timing of esophagogastroduodenoscopy (EGD) among patients admitted with upper gastrointestinal hemorrhage (UGIH) on weekends to those admitted on a weekday. Hospitals in 31 states from the Nationwide Inpatient Sample between 1998 and 2003 were included. This resulted in 75,636 patients admitted during the week and 23,339 admitted on a weekend with UGIH. Multivariable analyses were conducted to evaluate the effect of weekend admission on UGIH outcomes.

Results

Compared to patients admitted on a weekday, for those admitted on a weekend: in-hospital mortality was higher (unadjusted mortality 3.76 vs. 3.33%; P = 0.003; adjusted HR = 1.09, 95% CI = 1.00–1.18); adjusted length of stay was 1.7% longer (P = 0.0098); and adjusted in-hospital charges were 3.3% higher (P = 0.0038). Although these patients were less likely to undergo endoscopy (adjusted OR = 0.94; P = 0.004) and waited longer for this procedure (adjusted HR = 0.87; P < 0.001), these discrepancies did not fully explain their inferior outcomes.

Conclusions

Weekend admission for UGIH is associated with an increased risk of death, slightly longer lengths of stay, and marginally higher in-patient charges. Discrepancies in the use and timing of endoscopy do not account for these differences.

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Abbreviations

EGD:

Esophagogastroduodenoscopy

DRG:

Diagnosis related groups

HR:

Hazard ratio

ICD-9:

International classification of diseases, ninth revision

NIS:

Nationwide inpatient sample

OR:

Odds ratio

UGIH:

Upper gastrointestinal hemorrhage

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Acknowledgments

The authors thank Michael Kappelman, MD, MPH and Nicholas Shaheen MD, MPH for their critical review of this manuscript as well as Sara Hobbs Kohrt for editing and formatting the manuscript.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA

    Spencer D. Dorn

  2. Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA

    Nilay D. Shah, Bjorn P. Berg & James M. Naessens

  3. Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN, USA

    Nilay D. Shah

Authors
  1. Spencer D. Dorn
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  2. Nilay D. Shah
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  3. Bjorn P. Berg
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  4. James M. Naessens
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Corresponding author

Correspondence to Nilay D. Shah.

Additional information

All authors had access to the data and a role in the writing of this manuscript.

Appendix

Appendix

  1. 1.

    Primary diagnosis in group A.

  2. 2.

    Primary diagnosis in group B, secondary diagnosis in group A or group C.

  3. 3.

    Primary diagnosis in group C, secondary diagnosis in group B.

  4. 4.

    Primary diagnosis in group B, gastroscopy or esophagogastroduodenoscopy (EGD) performed, no colonoscopy performed.

See Table 5.

Table 5 Algorithmic definition of upper gastrointestinal hemorrhage
Full size table

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Dorn, S.D., Shah, N.D., Berg, B.P. et al. Effect of Weekend Hospital Admission on Gastrointestinal Hemorrhage Outcomes. Dig Dis Sci 55, 1658–1666 (2010). https://doi.org/10.1007/s10620-009-0914-1

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  • DOI: https://doi.org/10.1007/s10620-009-0914-1

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