Differences in the clinical course of 516 Japanese patients with upper gastrointestinal bleeding between weekday and weekend admissions

Fujita, Minoru; Manabe, Noriaki; Murao, Takahisa; Osawa, Motoyasu; Hirai, Shinsuke; Fukushima, Shinya; S, Yo; Nakato, Rui; Ishii, Manabu; Matsumoto, Hiroshi; Hata, Jiro; Shiotani, Akiko

doi:10.1080/00365521.2017.1377762

Cited by 7 publications

(10 citation statements)

References 35 publications

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“…24 Subsequent studies looking specifically at upper BGIT have shown an increase in mortality for non-variceal upper BGIT, attributed to the timing of endoscopy. 25,[34][35][36][37][38][39][40][41] Given that prompt endoscopic intervention is often required for upper BGIT, it has been postulated that patients admitted on weekends experienced a delay to endoscopic intervention, 25,42 which may be contributed by reduced staffing, lack of trained endoscopists or intensive care facilities over the weekends. 39 The above findings were similarly demonstrated in our study as well, where patients who were admitted after officehours were less likely to undergo endoscopic intervention within 12 h of presentation compared to those who presented during office-hours.…”

Section: Discussionmentioning

confidence: 99%

“…Bell and Redelmeier described this ‘weekend effect’ in mortality for patients admitted over the weekends compared to weekdays 24 . Subsequent studies looking specifically at upper BGIT have shown an increase in mortality for non‐variceal upper BGIT, attributed to the timing of endoscopy 25,34–41 . Given that prompt endoscopic intervention is often required for upper BGIT, it has been postulated that patients admitted on weekends experienced a delay to endoscopic intervention, 25,42 which may be contributed by reduced staffing, lack of trained endoscopists or intensive care facilities over the weekends 39 .…”

Section: Discussionmentioning

confidence: 99%

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Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients

Chue

Boey

et al. 2021

ANZ Journal of Surgery

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Background: Bleeding of the gastrointestinal tract (BGIT) is a common gastrointestinal emergency. There is no consensus whether this condition should be admitted to medical or surgical discipline. Timing of presentation may also impact patient outcomes due to differences in healthcare resource availability. This study thus aims to investigate the impact of admitting discipline and timing of admission on patient outcomes in BGIT. Methods: A 2-year tertiary institution database was retrospectively reviewed. Outcome measures included 30-day mortality, 30-day readmissions and rebleeding requiring repeat endoscopic, angiographic or surgical interventions. Secondary outcome measures included time to endoscopy, percutaneous angiographic interventions and surgery. The effect of admission discipline (medical versus surgical) and time of admission (office-hours versus after office-hours) were analysed using a propensity-score-adjusted estimate. Results: A total of 1384 patients were included for analysis, medical (n = 853), surgical (n = 530); during office-hours (n = 785) and after office-hours (n = 595). After propensityscore-adjusted analysis, no significant differences in mortality or readmissions were noted between medical or surgical admissions. Patients admitted under surgery were less likely to sustain rebleeding (P = 0.004) for lower BGIT and had an earlier time to endoscopy for upper BGIT (P = 0.04). Patients admitted after office-hours had similar outcomes with those admitted during office hours apart from a delay in time to endoscopy (P = 0.02). Conclusion:For BGIT patients, admission to a surgical discipline compared to a medical discipline appeared to have at least equivalent patient outcomes. Patients presenting with BGIT after office-hours were more likely to experience a delay to endoscopy, although it did not affect patient mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients

Chue

Boey

et al. 2021

ANZ Journal of Surgery

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“…Numerous studies have examined the impact of day of admission on UGIH outcomes. [10][11][12]19,[21][22][23][24][25][26][27] Although the individual studies have yielded varying results, a recent meta-analysis showed that weekend hospital admission was associated with 11% increase in mortality in patients with ANVH (OR: 1.11; 95% CI: 1.07-1.16; N = 9 studies) but found no difference in mortality among AVH patients (OR: 1.06; 95% CI: 0.99-1.13; N = 6 studies). 14 Importantly, this weekend effect was observed only in US studies but not in Asian or European studies.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Night-time Emergency Department Presentation on Upper Gastrointestinal Hemorrhage Outcomes

Alayo

Oyenuga

Adejumo

et al. 2021

Journal of Clinical Gastroenterology

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Goals:The aim was to investigate the impact of night-time emergency department (ED) presentation on outcomes of patients admitted for acute upper gastrointestinal hemorrhage (UGIH). Background:The relationship between time of ED presentation and outcomes of gastrointestinal hemorrhage is unclear. Study:Using the 2016 and 2017 Florida State Inpatient Databases which provide times of ED arrival, we identified and categorized adults hospitalized for UGIH to daytime (07:00 to 18:59 h) and night-time (19:00 to 06:59 h) based on the time of ED presentation. We matched both groups with propensity scores, and assessed their clinical outcomes including all-cause in-hospital mortality, inhospital endoscopy utilization, length of stay (LOS), total hospitalization costs, and 30-day all-cause readmission rates.Results: Of the identified 38,114 patients with UGIH, 89.4% (n = 34,068) had acute nonvariceal hemorrhage (ANVH), while 10.6% (n = 4046) had acute variceal hemorrhage (AVH). Compared with daytime patients, ANVH patients admitted at night-time had higher odds of in-hospital mortality (odds ratio: 1.32; 95% confidence interval: 1.06-1.60), lower odds of in-patient endoscopy (odds ratio: 0.83; 95% confidence interval: 0.77-0.90), higher total hospital costs ($9911 vs. $9545, P < 0.016), but similar LOS and readmission rates. Night-time AVH patients had a shorter LOS (5.4 vs. 5.8 d, P = 0.045) but similar mortality rates, endoscopic utilization, total hospitalization costs, and readmission rates as daytime patients.Conclusions: Patients arriving in the ED at night-time with ANVH had worse outcomes (mortality, hospitalization costs, and endoscopy utilization) compared with daytime patients. However, those with AVH had comparable outcomes irrespective of ED arrival time.

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“…The incidence of post‐procedural bleeding, the exacerbation of anemia, the development of embolism and the length of hospitalization were recorded, evaluated and compared between the two groups. Exacerbation of anemia was defined as a decrease in the hemoglobin concentration by ≥20 g/L as detected within 2 weeks after colonic EMR, as previously described . This study was approved by the Research Ethics Committees of the Kawasaki Medical School and Hospital (no.…”

Section: Methodsmentioning

confidence: 99%

“…Exacerbation of anemia was defined as a decrease in the hemoglobin concentration by ≥20 g/L as detected within 2 weeks after colonic EMR, as previously described. 10 This study was approved by the Research Ethics Committees of the Kawasaki Medical School and Hospital (no. 1789-2) and the Sakakibara Heart Institute of Okayama (no.…”

Section: Methodsmentioning

confidence: 99%

Colonic endoscopic mucosal resection in patients taking anticoagulants: Is heparin bridging therapy necessary?

Fujita

Murao

Osawa

et al. 2018

J of Digest Diseases

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Differences in the clinical course of 516 Japanese patients with upper gastrointestinal bleeding between weekday and weekend admissions

Abstract: There were no significant differences in the clinical outcomes of patients with UGIB admitted during daytime on weekdays and those admitted at nighttime or weekends partly owing to the sufficient performance of endoscopic hemostatic treatments.

Cited by 7 publications

References 35 publications

Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients

Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients

The Impact of Night-time Emergency Department Presentation on Upper Gastrointestinal Hemorrhage Outcomes

Colonic endoscopic mucosal resection in patients taking anticoagulants: Is heparin bridging therapy necessary?

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