“Weekend Effect” in Patients With Upper Gastrointestinal Hemorrhage: A Systematic Review and Meta-analysis

Gupta, Ashutosh; Agarwal, Rajender; Ananthakrishnan, Ashwin N.

doi:10.1038/ajg.2017.430

Cited by 35 publications

(33 citation statements)

References 47 publications

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“…A meta-analysis [16] reported that off-hours admission was significantly associated with an increased mortality and less timely endoscopy in patients with nonvariceal bleeding but not those with variceal bleeding. More recently, another meta-analysis [17] also had similar results. However, there were some limitations in previous studies.…”

Section: Introductionmentioning

confidence: 53%

“…Two of the published meta-analyses [16, 17] demonstrated a significant weekend effect on the mortality in patients with nonvariceal UGIB, but not those with variceal bleeding. This finding seemed to be consistent with our results regarding mortality.…”

Section: Discussionmentioning

confidence: 99%

“…First, meta-analyses have shown that geographical variation leads to different weekend effect on outcomes [16, 17]. A study, which included 571 patients suspected with upper gastrointestinal bleeding (UGIB) from 8 participating hospitals in the Netherlands [11], reported that patients admitted on weekends had higher mortality and rebleeding rate than those admitted on weekdays.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Admission Time on the Outcomes of Liver Cirrhosis with Acute Upper Gastrointestinal Bleeding: Regular Hours versus Off-Hours Admission

Han

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims Acute upper gastrointestinal bleeding (AUGIB) is a lethal complication of liver cirrhosis. We aimed to compare the outcomes of patients with liver cirrhosis and AUGIB who were admitted to hospital on regular hours and off-hours. Methods This retrospective study screened all cirrhotic patients with AUGIB who were admitted to our hospital from January 2010 to June 2014 for the test cohort and from December 2014 to March 2018 for the validation cohort. A 1:1 propensity score matching analysis was performed to adjust the Child-Pugh and MELD scores. In-hospital mortality, 5-day rebleeding rate, length of stay, and total payment were primary outcomes. Results Overall, 826 and 173 patients with liver cirrhosis and AUGIB were included in the test and validation cohorts, respectively. After propensity score matching, 226 and 40 patients were included in the test and validation cohorts, respectively. The overall analysis of the test cohort found significantly higher Child-Pugh score (P=0.006), 5-day rebleeding rate (18.69% versus 10.72%, P=0.001), and total payment (¥25,906.83 versus ¥22,017.42, P<0.001) in patients admitted on off-hours. By contrast, the overall analysis of the validation cohort did not find any difference in Child-Pugh score, 5-day rebleeding, in-hospital mortality, length of stay, or hospital payment between patients admitted on regular hours and off-hours. Similarly, the propensity score matching analyses of both test and validation cohorts found no difference in these primary outcomes between the two groups. Conclusions Off-hours admission might not be negatively associated with the outcomes of patients with liver cirrhosis and AUGIB.

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Section: Introductionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Admission Time on the Outcomes of Liver Cirrhosis with Acute Upper Gastrointestinal Bleeding: Regular Hours versus Off-Hours Admission

Han

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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“…Even with conditions associated with adverse weekend effects, conflicting outcomes have been reported13–15 16–19 and similarly to medical presentations, surgical and intensive care unit (ICU) studies have conflicting results 9 10 20–32. These findings suggest that adverse weekend effects are complex, disease specific and may have different underlying causes including service structure 19. Despite this, a recent assessment of the impact of enhanced 7-day working practices in the UK did not show a beneficial impact on adverse weekend outcomes 33…”

Section: Introductionmentioning

confidence: 99%

Is liver transplantation ‘out-of-hours’ non-inferior to ‘in-hours’ transplantation? A retrospective analysis of the UK Transplant Registry

et al. 2019

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ObjectivesIncreased morbidity and mortality have been associated with weekend and night-time clinical activity. We sought to compare the outcomes of liver transplantation (LT) between weekdays and weekends or night-time and day-time to determine if ‘out-of-hours’ LT has acceptable results compared with ‘in-hours’.Design, setting and participantsWe conducted a retrospective analysis of patient outcomes for all 8816 adult, liver-only transplants (2000–2014) from the UK Transplant Registry.Outcome measuresOutcome measures were graft failure (loss of the graft with or without death) and transplant failure (either graft failure or death with a functioning graft) at 30 days, 1 year and 3 years post-transplantation. The association of these outcomes with weekend versus weekday and day versus night transplantation were explored, following the construction of a risk-adjusted Cox regression model.ResultsSimilar patient and donor characteristics were observed between weekend and weekday transplantation. Unadjusted graft failure estimates were 5.7% at 30 days, 10.4% at 1 year and 14.6% at 3 years; transplant failure estimates were 7.9%, 15.3% and 21.3% respectively.A risk-adjusted Cox regression model demonstrated a significantly lower adjusted HR (95% CI) of transplant failure for weekend transplant of 0.77 (0.66 to 0.91) within 30 days, 0.86 (0.77 to 0.97) within 1 year, 0.89 (0.81 to 0.99) within 3 years and for graft failure of 0.81 (0.67 to 0.97) within 30 days. For patients without transplant failure within 30 days, there was no weekend effect on transplant failure. Neither night-time procurement nor transplantation were associated with an increased hazard of transplant or graft failure.ConclusionsWeekend and night-time LT outcomes were non-inferior to weekday or day-time transplantation, and we observed a possible small beneficial effect of weekend transplantation. The structure of LT services in the UK delivers acceptable outcomes ‘out-of-hours’ and may offer wider lessons for weekend working structures.

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“…Transfer status on the weekend for emergent cases like abdominal aortic aneurysm rupture may be associated with higher mortality than weekday transfers. 13 Inconsistency in quality and access to care on the weekends 14 and acute changes in patient status occurring on weekends requiring procedural intervention 15 have been proposed mechanisms for this weekend effect. For ALI, these processes may also contribute to differential patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

Ilagan‐Ying

Taddei

2019

Health Science Reports

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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.

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“Weekend Effect” in Patients With Upper Gastrointestinal Hemorrhage: A Systematic Review and Meta-analysis

Cited by 35 publications

References 47 publications

Effect of Admission Time on the Outcomes of Liver Cirrhosis with Acute Upper Gastrointestinal Bleeding: Regular Hours versus Off-Hours Admission

Effect of Admission Time on the Outcomes of Liver Cirrhosis with Acute Upper Gastrointestinal Bleeding: Regular Hours versus Off-Hours Admission

Is liver transplantation ‘out-of-hours’ non-inferior to ‘in-hours’ transplantation? A retrospective analysis of the UK Transplant Registry

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

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