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Weekend admission tied to bleeding peptic ulcers

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients who are admitted on a weekend for bleeding peptic ulcers have worse survival than their peers admitted on a weekday, according to the results of two studies appearing Clinical Gastroenterology and Hepatology for March.

By contrast, weekend admission for hemorrhage due to bleeding varices is not associated with increased mortality, findings from one of the studies shows.

Prior research has shown that a number of medical conditions have poorer outcomes when patients are admitted on weekends. Whether the same held true for upper gastrointestinal hemorrhage was unclear, although the limited availability of urgent endoscopic intervention on weekends suggests that this may be the case.

In the first study, Dr. Ashwin N. Ananthakrishnan, from the Medical College of Wisconsin, Milwaukee, and colleagues took up this topic by analyzing data from the Nationwide Inpatient Sample 2004, which featured 28,820 discharges with acute variceal hemorrhage and 391,119 with acute nonvariceal hemorrhage.

With nonvariceal hemorrhage, weekend admission increased in-hospital morality by 21% and reduced the likelihood of early (within 1 day of admission) endoscopy by 36%.

With variceal hemorrhage, by contrast, weekend admission did not increase mortality, but it did reduce the odds of early endoscopy at nonteaching hospitals.

Early endoscopy was linked to both shorter hospital stays and to lower hospital charges, the report indicates.

In the second study, Dr. Abdel Aziz M. Shaheen, from the University of Calgary, Alberta, focused solely on bleeding from peptic ulcer disease. Their study, which incorporated data from the 1993-2005 US Nationwide Inpatient Sample, featured 237,412 admissions to 3166 hospitals for peptic ulcer-related bleeding.

Mortality was higher in weekend- versus weekday-admitted cases: 3.4% vs. 3.0%. Likewise, weekend-admitted patients were more likely to undergo surgery, had longer hospital stays, and incurred greater hospital charges.

The average time to endoscopy was 2.21 days for weekend-admitted cases versus 2.06 days for those admitted on a weekday (p < 0.0001). Thirty percent of weekend cases underwent endoscopy the same day compared with 34% of weekday cases (p < 0.0001).

Multivariate analysis confirmed that weekend admission was an independent predictor of increased mortality.

“Although wait times for endoscopy are prolonged in patients hospitalized on the weekend, this delay does not appear to medicate the observed weekend effect for mortality,” Dr. Shaheen’s team states. “Future studies,” they add, “should explore alternative processes of care that might mediate this effect in patients with bleeding peptic ulcers.”

Clinical Gastroenterol Hepatol 2009;7:296-310.