Weekend Admission Does Not Influence the Mortality of Upper Gastrointestinal Bleeding Caused by Peptic Ulcers: Results of a French Prospective Study of the Association Nationale des Gastroentérologues des Hôpitaux Généraux Group
Article Outline
Dear Editor:
In 2 studies recently published in Clinical Gastroenterology and Hepatology, patients with upper gastrointestinal bleeding (UGIB) admitted to hospitals on weekends were more likely to die and less likely to undergo endoscopy on the day of admission than those admitted on weekdays.1, 2
In a post hoc subanalysis of a prospective study performed in 53 general non-university hospitals,3 we compared the prognostic factors of UGIB caused by peptic ulcers in 965 patients according to weekend or weekday admission. The main results are presented in Table 1.
Table 1. Characteristics of and Prognostic Factors in Patients Hospitalized for UGIB According to Weekend or Weekday Admission
| Weekend | Weekday | P value | |
|---|---|---|---|
| No. of patients | 208 | 757 | |
| Mean age (y) | 64.3 ± 19.7 | 67.2 ± 18.4 | .03a |
| Hospitalization in intensive care unit | 37 (17.8%) | 98(13%) | .07 |
| Mean Rockall score (±SD) | 5 ± 2.4 | 4.8 ± 2.2 | .11 |
| Mean rate of comorbidity (±SD) | 1.05 ± 1.23 | 1.14 ± 1.19 | .16 |
| Mean time to endoscopy (±SD) (d) | 0.47 ± 0.67 | 0.95 ± 1.6 | .00002a |
| Active bleeding | 134(64.4%) | 419(55.4%) | .02a |
| Endoscopic treatment in case of active bleeding | 191/419(45.5%) | 58/134(43.3%) | .64 |
| Rebleeding rate | 30(14.4%) | 91(12%) | .35 |
| Surgery rate | 13(6.5%) | 38(5%) | .48 |
| Mortality rate | 8(3.8%) | 48(6.3%) | .17 |
| Mean hospital stay (d) | 9.1 ± 9.4 | 9.3 ± 8.9 | .42 |
aComparisons between groups were made by using a t test or χ2 test when appropriate. |
We did not observe a higher rate of mortality during weekends, and the mean time to endoscopy was even shorter during weekends. This could be explained by the following: first, we did not observe any difference regarding the severity of bleeding estimated by the Rockall score. Second, we found that the rate of endoscopic intervention for active bleeding did not differ between weekend and weekday admissions. This result is in accordance with that of Ananthakrishnan et al2; they observed that the difference in mortality for weekend admissions was significant only among the patients who did not undergo endoscopic intervention, with similar outcomes among the group that did receive emergency endoscopy. Third and probably most importantly, an on-call gastrointestinal senior was available on weekends in nearly all our hospitals.
In conclusion, in our study we did not find any weekend effect leading to poorer outcome in patients bleeding from peptic ulcers. This could be explained by a shorter delay in the performance of endoscopy for weekend admissions.
References
- . Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol. 2009;7:303–310
- Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis. Clin Gastroenerol Hepatol. 2009;7:296–302
- Favorable prognosis of upper-gastrointestinal bleeding in 1041 older patients: results of a prospective multicenter study. Clin Gastroenterol Hepatol. 2008;6:886–892
Conflicts of interest The authors disclose no conflicts.
Funding This study was sponsored by Sanofi-Aventis and the French Society of Gastroenterology (SNFGE).
PII: S1542-3565(09)00263-8
doi:10.1016/j.cgh.2009.03.018
© 2009 AGA Institute. Published by Elsevier Inc. All rights reserved.
