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Weekday versus Weekend Admissions for Upper Gastrointestinal Bleeding: Is There a True Difference in Patient Outcomes? A Meta-analysis


Hinds, Alisha DO; Ahmad, Dina MD; Lopez, Kristi MD; Matteson, Michelle PhD; Bechtold, Matthew MD, FACG

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American Journal of Gastroenterology: October 2013 - Volume 108 - Issue - p S479
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Purpose: Patient outcomes from weekend admissions and procedures have increased morbidity and mortality in a variety of different specialties, known as the “weekend” effect. Upper gastrointestinal bleeding (UGIB) is a serious condition that accounts for large number of hospitalizations each year around the world. Multiple studies have been performed comparing outcomes on patients with UGIB admitted on weekends versus weekdays with various results. Therefore, we performed a metaanalysis on the outcomes of weekend versus weekday admissions for UGIB.

Methods: A comprehensive search of PubMed/MEDLINE, Scopus, and Cochrane databases was performed (November 2012). All studies (cross-sectional, prospective, and retrospective) comparing weekend to weekday outcomes in patients with UGIB were included. Two authors independently extracted data. Meta-analysis was performed using fixed and random effects models with odds ratio (OR) or mean difference (MD) to assess for mortality, need for surgery, length of stay, time to endoscopy, and endoscopy on admission day. Publication bias was assessed using funnel plots. Heterogeneity was assessed by calculating the I2 measure of inconsistency. RevMan 5.1 was utilized for statistical analysis.

Results: Eleven studies met the inclusion criteria (N=870,374). Patients admitted on the weekend for UGIB experienced a statistically significant increase in mortality (OR 1.13; 95% CI: 1.06-1.20, p<0.01), need for surgery (OR 2.46; 95% CI: 1.51-3.99, p<0.01), and time to endoscopy (MD 2.68; 95% CI: 0.17-5.20, p=0.04) as compared to weekday admissions. Furthermore, weekend admissions for UGIB demonstrated a statistically significant reduction in endoscopy on day of admission (OR 0.72; 95% CI: 0.62-0.85, p<0.01). No statistically significant difference was noted for length of hospital stay (p=0.15) between the two groups.

Conclusion: Patients admitted on weekends with UGIB are more likely to have poorer outcomes than patients admitted during weekdays. Therefore, future policies are necessary to help reduce or eliminate such discrepancies between weekend and weekday admissions for UGIB.

© The American College of Gastroenterology 2013. All Rights Reserved.