112 Mortality From Acute Upper Gastro-Intestinal Bleeding in the UK – Does it Display a “Weekend Effect”?

Abstract

Introduction A number of medical and surgical conditions demonstrate an association between presentation to hospital at the weekend and increased mortality. Potential reasons for this “weekend effect” include reduced staffing levels and a lower likelihood to undergo invasive procedures. Acute Upper Gastrointestinal Bleeding (AUGIB) is an ideal condition to examine weekend/weekday mortality as it has a substantial mortality (10%) and may require early access to upper endoscopy to achieve haemostasis. A recent UK nationwide audit of patients admitted with AUGIB revealed that the majority of AUGIB patients (59%) present out of hours and only half of UK hospitals have a formal out-of-hours endoscopy service.1 Methods To analyse whether weekend presentations for AUGIB have a higher mortality compared with those patients presenting on weekdays. Further analyses were performed on patients included in the 2007 UK Comparative Audit of Upper Gastrointestinal Bleeding and the Use of Blood.1 Weekend presentation was defined as any patient presenting between midnight on Friday through to midnight on Sunday. Results Data were analysed on 6750 patients across 208 UK hospitals, including both new admissions with AUGIB (5550/6750) and existing in-patients (1107/6750). Patient characteristics were comparable with no significant difference between mean Rockall score at presentation, mean number of comorbidities, receipt of red cell transfusion, therapeutic endoscopy for actively bleeding lesions, length of hospital stay and surgery. The only notable difference was that a significantly smaller percentage of patients were endoscoped either within 12 or 24 h on the weekend. Despite this delay to earlier endoscopy there was no significant difference in mortality between patients presenting on the weekend (9.9%) or during the weekdays (10%). Subanalysis of new admissions only similarly showed no difference in mortality for weekend (7%, 86/1228) vs weekday (6.8%, 293/4321) presentation. Conclusion In this large nationwide UK audit, we found no overall difference in mortality in patients presenting with AUGIB on weekends as compared with those presenting on weekdays. This is despite delay to early endoscopy on weekends, a large proportion of hospitals without out-of-hours endoscopy services, and other likely organisational factors on weekends including reduced staffing patterns of physicians, nurses and other support staff.