Association between weekend admission and mortality for upper gastrointestinal hemorrhage: an observational study and meta-analysis.

Abstract

Higher in-hospital mortality for weekend vs. weekday admissions has been described. We performed a retrospective study and accompanying meta-analysis to examine the association between weekend admission for upper gastrointestinal hemorrhage (UGIH) and in-hospital mortality. We identified adult admissions to United States (US) hospitals for acute variceal and nonvariceal UGIH between 1/2010 and 12/2012 from the National Inpatient Sample (NIS). We used multivariable logistic regression to compare the odds of in-hospital mortality (adjusting for hospital- and patient-level factors) for weekend vs. weekday admissions. For our meta-analysis, we searched MEDLINE and SCOPUS to identify NIS studies. Using cumulative meta-analysis, we calculated the adjusted odds ratio (aOR) of in-hospital mortality for variceal and nonvariceal UGIH weekend admission. From 2010 to 2012, we identified 119,353 admissions for UGIH. After multivariable adjustment, there was no difference in the odds of mortality for weekend admissions with variceal (aOR 1.00; 95% CI 0.81-1.23) or nonvariceal UGIH (aOR 1.10; 95% CI 0.99-1.22); although, a decreased use of endoscopy in weekend admissions for all-cause UGIH (adjusted hazard ratio 0.91; 95% CI 0.89-0.92) was observed. Meta-analysis of five studies (including our own) shows no association between weekend admission and mortality for variceal UGIH (aOR 1.02; 95% CI 0.86-1.21). Weekend admission for nonvariceal UGIH is associated with an increased odds of mortality (aOR 1.09; 95% CI 1.04-1.15). Weekend admission for UGIH is not associated with a higher odds of in-hospital mortality in our observational study. However, we observed a 9.0% increase in nonvariceal UGIH mortality for weekend admissions in our meta-analysis.