Upper gastrointestinal bleeding in Scotland 2000-2010: Improved outcomes but a significant weekend effect

Ahmed, Asma; Armstrong, Matthew; Robertson, I; Morris, Allan J.; Blatchford, Oliver; Stanley, Adrian J.

doi:10.3748/wjg.v21.i38.10890

Cited by 48 publications

(70 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Mortality was in-hospital in all studies in North America, whereas 30-day mortality was reported in some studies in Asia 8,12 and Europe. 2,3,7,[19][20][21][22] Thirty-day mortality includes all-cause deaths occurring only within 30 days of hospitalization and after being discharged from the hospital. For in-hospital mortality, all mortality will be counted, so long as the patient stays in the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,5,7,[18][19][20][21][22] Six studies reported patients with UGIH caused by peptic ulcer, 8,10,12,19,20,22 one study included patients with bleeding gastroduodenal angiodysplasia, 17 three demonstrated the sources of bleeding were from the esophagus varix, 11,13,15 and 10 studies included patients with both variceal and nonvariceal UGIH. 2,3,[5][6][7]14,16,18,21,22 Most recruited studies defined the ''off-hours'' as weekends only, [4][5][6][7]11,[13][14][15][16][17]21 while four studies defined it as weekends and public holidays; 3,8,12,18 one study defined it as weekends and nighttime, 20 and one study defined it as nighttime only. 19 Three studies reported results by comparison to weekend admissions as well as nighttime admissions.…”

Section: Description Of the Eligible Studiesmentioning

confidence: 99%

“…2,10,22 In order to avoid repeated calculation, we combined only weekend admissions for the current analysis. All studies were designed as cohorts; 17 were retrospective [3][4][5][6][7][8][10][11][12][13][14][15][16][17][18]21,22 and three were prospective. 2,19,20 We contacted the authors of one of the included studies and obtained additional information for our analysis.…”

Section: Description Of the Eligible Studiesmentioning

confidence: 99%

“…2,19,20 We contacted the authors of one of the included studies and obtained additional information for our analysis. 21 Seven studies analyzed the same administrative database (the United States National Inpatient Sample (NIS)); 4,6,[15][16][17]23,24 we finally included five with the most recent year of publication to avoid overlapping sets of patients. 4,6,[15][16][17] NOS assessment indicated that seven cohorts had moderate quality and 13 cohorts had high quality (Supplementary Table 1).…”

Section: Description Of the Eligible Studiesmentioning

confidence: 99%

“…Of these, 10 studies reported in-hospital mortality, [4][5][6]10,11,13,[15][16][17][18] nine reported 30-day mortality, 2,3,7,8,12,[19][20][21][22] and one reported both. 14 The result of meta-analysis showed that patients who were admitted during off-hours had (Table 2).…”

Section: Primary Outcome: Mortalitymentioning

confidence: 99%

See 4 more Smart Citations

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

Xia

Chiu

Tsoi

et al. 2017

United European Gastroenterology Journal

View full text Add to dashboard Cite

Objective: The objective of this article is to evaluate the relationship between off-hours hospital admission (weekends, public holidays or nighttime) and mortality for upper gastrointestinal hemorrhage (UGIH). Methods: Medline, Embase, Scopus, and the Chinese Biomedical Literature were searched through December 2016 to identify eligible records for inclusion in this meta-analysis. A random-effects model was applied. Results: Twenty cohort studies were included for analysis. Patients with UGIH who were admitted during off-hours had a significantly higher mortality and were less likely to receive endoscopy within 24 hours of admission. In comparison to variceal cases, patients with nonvariceal bleeding showed a higher mortality when admitted during off-hours. However, for studies conducted in hospitals that provided endoscopy outside normal hours, off-hours admission was not associated with an increased risk of mortality. Conclusion: Our study showed a higher mortality for patients with nonvariceal UGIH who were admitted during off-hours, while this effect might be offset in hospitals with a formal out-of-hours endoscopy on-call rotation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Description Of the Eligible Studiesmentioning

confidence: 99%

Section: Description Of the Eligible Studiesmentioning

confidence: 99%

Section: Description Of the Eligible Studiesmentioning

confidence: 99%

Section: Primary Outcome: Mortalitymentioning

confidence: 99%

See 3 more Smart Citations

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

Xia

Chiu

Tsoi

et al. 2017

United European Gastroenterology Journal

View full text Add to dashboard Cite

show abstract

Weekend admission and mortality for gastrointestinal disorders across England and Wales

Roberts

Brown

Thorne

et al. 2017

British Journal of Surgery

View full text Add to dashboard Cite

BackgroundLittle has been reported on mortality following admissions at weekends for many gastrointestinal (GI) disorders. The aim was to establish whether GI disorders are susceptible to increased mortality following unscheduled admission on weekends compared with weekdays.MethodsRecord linkage was undertaken of national administrative inpatient and mortality data for people in England and Wales who were hospitalized as an emergency for one of 19 major GI disorders.ResultsThe study included 2 254 701 people in England and 155 464 in Wales. For 11 general surgical and medical GI disorders there were little, or no, significant weekend effects on mortality at 30 days in either country. There were large consistent weekend effects in both countries for severe liver disease (England: 26·2 (95 per cent c.i. 21·1 to 31·6) per cent; Wales: 32·0 (12·4 to 55·1 per cent) and GI cancer (England: 21·8 (19·1 to 24·5) per cent; Wales: 25·0 (15·0 to 35·9) per cent), which were lower in patients managed by surgeons. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43·3 per cent in England and 51·4 per cent in Wales) and GI cancer (by 44·6 and 52·8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons.DiscussionThere is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. The findings for severe liver disease may suggest a lack of specialist hepatological resources. For cancers, reduced availability of end‐of‐life care in the community at weekends may be the cause.

show abstract

Analysis of weekend effect in severe acute liver injury: A nationwide database study

Ilagan‐Ying

Taddei

2019

Health Science Reports

View full text Add to dashboard Cite

Background and Aims Severe acute liver injury (ALI) can lead to poor outcomes without timely management. Comparatively worse outcomes in various severe, emergent conditions have been attributed to reduced hospital resources experienced by patient weekend admissions, a phenomenon termed “weekend effect.” To date, a weekend effect has not been studied in severe ALI, an emergency also necessitating timely management. We aimed to evaluate such an effect in this condition by analyzing a large national inpatient database in the United States. Methods We analyzed the Nationwide/National Inpatient Sample (NIS) 2000 to 2014, the largest inpatient, all‐payer database in the United States (US), containing sociodemographic, clinical, patient‐, and hospital‐level data. We identified severe ALI using International Classification of Disease, 9th Revision diagnosis codes for acute/subacute hepatic necrosis (570) with encephalopathy (572.2). Our primary outcome was in‐hospital mortality. Using a full‐model approach for covariate selection, we performed multiple logistic regression modeling to assess for weekend effect and identify predictors of in‐hospital mortality. Results We identified 15 762 eligible hospitalizations, with 12 182 (77.3%) having complete covariate data. This sample comprised 53.3% males, 69.3% White race, and had an average (± SD) age of 55.0 ± 14.1 years. We utilized a full‐model approach for covariate inclusion but did not include patient transfer data due to limited availability. We observed no significant mortality differences in weekend admissions (OR = 1.06, 95% CI: 0.97‐1.15, P = 0.02). However, significantly higher mortality was associated with male sex, older age, Black or Hispanic race, Northeast US hospitalization, urban teaching status, and larger hospital size. Sensitivity analyses using multiple imputation datasets and transfer covariates did not change our results. Conclusion We did not observe a weekend effect of in‐hospital mortality for weekend admissions for severe ALI, but our overall diagnosis ascertainment yield was low—indicating that lack of accurate documentation for the etiology of severe ALI may be masking an effect. Additionally, our findings suggest that racial differences and hospital‐level characteristics in the context of severe ALI may be associated with varying outcomes, regardless of admission day, which warrants further research.

show abstract

Upper gastrointestinal bleeding in Scotland 2000-2010: Improved outcomes but a significant weekend effect

Abstract: Despite reduction in mortality for UGIB in Scotland during 2000-2010, weekend admissions show a consistently higher mortality and greater lengths of stay compared with weekdays.

Cited by 48 publications

References 32 publications

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

Weekend admission and mortality for gastrointestinal disorders across England and Wales

Analysis of weekend effect in severe acute liver injury: A nationwide database study

Contact Info

Product

Resources

About