Impact of day of admission on mortality and other outcomes in upper GI hemorrhage: a nationwide analysis

Abstract

Background: Studies have reached varying conclusions regarding the association between day of admission and outcomes in patients with upper GI hemorrhage (UGIH).

Objectives: To evaluate whether important outcomes in UGIH, including in-hospital mortality, differ between patients admitted on weekends versus weekdays.

Design and setting: Retrospective cohort study by using the 2009 Nationwide Inpatient Sample.

Patients: Patients were included if they were adults with a principal diagnosis of acute UGIH. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions.

Main outcome measurements: In-hospital mortality, in-hospital endoscopy, endoscopic therapy, length of stay, and total hospitalization charges.

Results: The study included 199,008 patients with nonvariceal UGIH and 3251 patients with variceal UGIH. Compared with patients admitted on weekdays, patients with nonvariceal UGIH admitted on weekends had similar adjusted in-hospital mortality rates (odds ratio [OR] 1.11; 95% confidence interval [CI], 0.93-1.30), endoscopic therapy rates (OR 0.98; 95% CI, 0.92-1.04), and length of stay (P = .09), but had lower early endoscopy rates (within 24 hours)(OR 0.64; 95% CI, 0.60-0.67), lower in-hospital endoscopy rates (OR 0.84; 95% CI, 0.78-0.91), and higher hospitalization charges (mean increase, $1558; P = .01). Patients with variceal UGIH admitted on weekends and weekdays did not differ in any of these outcomes.

Limitations: Retrospective data, administrative database.

Conclusions: Compared with patients admitted on weekdays, patients with nonvariceal UGIH admitted on weekends had similar mortality rates and lengths of stay, but lower endoscopy rates and higher hospitalization charges. Patients with variceal GI hemorrhage had similar outcomes regardless of day of admission.