Weekend Versus Weekday Admission and Mortality From Gastrointestinal Hemorrhage Caused by Peptic Ulcer Disease

Background & Aims

Management of upper gastrointestinal bleeding (UGIB) often requires urgent endoscopic intervention; limitations in its availability on weekends might be associated with increased mortality, compared with patients admitted on weekdays.

Methods

We used the 1993–2005 U.S. Nationwide Inpatient Sample to identify patients hospitalized for UGIB caused by peptic ulceration. Differences in in-hospital mortality between patients admitted on weekends and weekdays were evaluated by using logistic regression models, adjusting for patient and clinical factors including the timing of upper endoscopy.

Results

Between 1993 and 2005, there were 237,412 admissions to 3,166 hospitals for peptic ulcer–related UGIB. Compared with patients admitted on a weekday, those admitted on the weekend had an increased risk of death (3.4% vs 3.0%; adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.02–1.15), higher rates of surgical intervention (3.4% vs 3.1%; OR, 1.09; 95% CI, 1.03–1.15), prolonged hospital stays, and increased hospital charges (P < .0001 for all comparisons). Patients admitted on the weekend had a longer mean time to endoscopy (2.21 ± 0.01 vs 2.06 ± 0.01 days; P < .0001) and were less likely to undergo endoscopy on the day of admission (30% vs 34%; P < .0001). After adjusting for the timing of endoscopy, weekend admission remained an independent predictor of increased mortality (OR, 1.12; 95% CI, 1.05–1.20).

Conclusions

Patients admitted to hospital on the weekend for peptic ulcer–related hemorrhage have higher mortality and more frequently undergo surgery. Although wait times for endoscopy are prolonged in patients hospitalized on the weekend, this delay does not appear to mediate the weekend effect for mortality.

Abbreviations used in this paper: CI, confidence interval, HCUP, Healthcare Cost and Utilization Project, ICD-9-CM, International Classification of Diseases 9th Version, Clinical Modification, IQR, interquartile range, LOS, length of stay, NIS, Nationwide Inpatient Sample, OR, odds ratio, UGIB, upper gastrointestinal bleed