Weekend effect in upper gastrointestinal bleeding: a systematic review and meta-analysis

Shih, Pei-Ching; Liu, Shu-Jung; Li, Sung-Tse; Chiu, Ai-Chen; Wang, Po-Chuan; Liu, Lawrence Yu‐Min

doi:10.7717/peerj.4248

Cited by 21 publications

(24 citation statements)

References 41 publications

(61 reference statements)

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“…We found that the use of clinical audit data did not necessarily mean that measures of severity were included in the analysis [ 39 ] and that measures of severity inevitably varied. In a systematic review of the effect of weekend admission on outcomes for patients with upper gastrointestinal bleeding, variceal bleeding was not associated with weekend admission, but non-variceal bleeding was, suggesting that a more sophisticated approach than a ‘severity measure’ may be important and may be disease-specific [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Honeyford

Cecil

et al. 2018

BMC Health Serv Res

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BackgroundThe concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals.MethodsThis is a systematic review and meta-analysis of published studies on the weekend effect in UK hospitals. We used EMBASE, MEDLINE, HMIC, Cochrane, Web of Science and Scopus to search for relevant papers. We included systematic reviews, randomised controlled trials and observational studies) on patients admitted to hospital in the UK and published after 2001. Our outcome was death; studies reporting mortality were included. Reviewers identified studies, extracted data and assessed the quality of the evidence, independently and in duplicate. Discrepancy in assessment was considered by a third reviewer. All meta-analyses were performed using a random-effects meta-regression to incorporate the heterogeneity into the weighting.ResultsForty five articles were included in the qualitative synthesis. 53% of the articles concluded that outcomes for patients either undergoing surgery or admitted at the weekend were worse. We included 39 in the meta-analysis which contributed 50 separate analyses. We found an overall effect of 1.07 [odds ratio (OR)] (95%CI:1.03–1.12), suggesting that patients admitted at the weekend had higher odds of mortality than those admitted during the week. Sub-group analyses suggest that the weekend effect remained when measures of case mix severity were included in the models (OR:1.06 95%CI:1.02–1.10), but that the weekend effect was not significant when clinical registry data was used (OR:1.03 95%CI: 0.98–1.09). Heterogeneity was high, which may affect generalisability.ConclusionsDespite high levels of heterogeneity, we found evidence of a weekend effect in the UK, even after accounting for severity of disease. Further work is required to examine other potential explanations for the “weekend effect” such as staffing levels and other organisational factors.Trial registrationPROSPERO International Prospective Register of Systematic Reviews -registration number: CRD42016041225.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3688-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Honeyford

Cecil

et al. 2018

BMC Health Serv Res

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“…Although a retrospective study from Japan concluded that the clinical outcomes of patients who underwent emergency endoscopic hemostasis for acute UGIH outside regular hours did not differ from those of patients treated during regular hours [100], two systematic reviews/meta-analyses found otherwise [95,101]. Xia et al reported that NVUGIH patients who were admitted out of hours had significantly higher mortality and received less timely endoscopy [95].…”

Section: On-call Gi Endoscopy Resourcesmentioning

confidence: 99%

“…Xia et al reported that NVUGIH patients who were admitted out of hours had significantly higher mortality and received less timely endoscopy [95]. Shih and colleagues showed that the "weekend effect" was associated with increased mortality in UGIH patients, particularly in patients with NVUGIH [101].…”

Section: On-call Gi Endoscopy Resourcesmentioning

confidence: 99%

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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MAIN RECOMMENDATIONS 1 ESGE recommends in patients with acute upper gastrointestinal hemorrhage (UGIH) the use of the Glasgow–Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.Strong recommendation, moderate quality evidence. 2 ESGE recommends that in patients with acute UGIH who are taking low-dose aspirin as monotherapy for secondary cardiovascular prophylaxis, aspirin should not be interrupted. If for any reason it is interrupted, aspirin should be re-started as soon as possible, preferably within 3–5 days.Strong recommendation, moderate quality evidence. 3 ESGE recommends that following hemodynamic resuscitation, early (≤ 24 hours) upper gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high quality evidence. 4 ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved. Strong recommendation, high quality evidence. 5 ESGE recommends for patients with actively bleeding ulcers (FIa, FIb), combination therapy using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical therapy). Strong recommendation, high quality evidence. 6 ESGE recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), contact or noncontact thermal therapy, mechanical therapy, or injection of a sclerosing agent, each as monotherapy or in combination with epinephrine injection. Strong recommendation, high quality evidence. 7 ESGE suggests that in patients with persistent bleeding refractory to standard hemostasis modalities, the use of a topical hemostatic spray/powder or cap-mounted clip should be considered. Weak recommendation, low quality evidence. 8 ESGE recommends that for patients with clinical evidence of recurrent peptic ulcer hemorrhage, use of a cap-mounted clip should be considered. In the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE. Strong recommendation, moderate quality evidence. 9 ESGE recommends high dose proton pump inhibitor (PPI) therapy for patients who receive endoscopic hemostasis and for patients with FIIb ulcer stigmata (adherent clot) not treated endoscopically. (a) PPI therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (b) High dose PPI therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.Strong recommendation, high quality evidence. 10 ESGE recommends that in patients who require ongoing anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the bleeding has been controlled, preferably within or soon after 7 days of the bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral anticoagulants (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this context.Strong recommendation, low quality evidence.

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“…Hence, in this study we included UGIB patients with variceal and nonvariceal bleeding. The importance of the timing of endoscopy in UGIB is further highlighted by the report of weekend effect, whereby the prognosis of patients presenting after hours may be worse [10,11].…”

Section: Introductionmentioning

confidence: 99%

Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding

et al. 2019

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Background/AimsThe role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. MethodsThis retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding.ResultsA total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. ConclusionsVery early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.

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Weekend effect in upper gastrointestinal bleeding: a systematic review and meta-analysis

Cited by 21 publications

References 41 publications

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding

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