S678 The Impact of Weekend Effects on Esophageal Variceal Bleeding; A Retrospective Cohort Study Comparing: Mortality, Total Charges, and Length of Stay

Abstract

Introduction: Esophageal variceal bleeding is an acute illness that can present at any day of the week; however, hospitals are typically staffed differently during weekdays as compared to weekends. Consequently, patients who present with acute medical illnesses during the weekend can potentially receive delays in management due to resource limitations, which can lead to extended hospitalizations, higher costs, and possibly higher mortality. The primary aim of our study is to determine whether outcomes related to hospital mortality, length of stay, and direct charges for patients presenting with esophageal variceal bleeding differ between those admitted during the week or on weekends. Methods: A retrospective analysis utilizing the de-identified data from the National Inpatient Sample (NIS) was used to analyze patients hospitalized with esophageal variceal bleeding from 2004 through 2014. Hospital encounters for esophageal variceal bleeding were identified using the International Classification of Diseases (ICD-9) diagnostic codes; codes ‘4560’, ‘45620’, and ‘45621’. We extracted baseline demographic data including age, race, income, insurance status, and mortality rate. Categorical variables were compared using the chi-square test, and continuous variables were compared using the t-test. P-values less than 0.05 indicated a statistically significant association. The odds ratio and 95% confidence interval were also calculated. Data analysis was done using STATA Statistical Software, Release 16 (College Station, TX: StataCorp LLC). Results: A total of 207,023 admissions for esophageal variceal bleeding were identified, of which 23.4% occurred during the weekend. Mortality was higher for patients admitted during the weekend as compared to those admitted during the weekdays (7.5% vs. 7.0%, p < 0.01), despite a higher proportion of patients admitted during the weekend undergoing upper endoscopy as compared to the weekdays (24.4% vs. 23.9%, p=0.02). Trans-jugular intrahepatic shunt utilization was higher during the week than the weekend (2.9% vs. 2.6%, p< 0.01). Length of stay is shorter on weekends (6.15 vs. 6.29 days). Conclusion: Weekend admission for esophageal variceal bleeding is associated with an increased risk of death, slightly shorter lengths of stay, and marginally fewer in-patient charges. Discrepancies in the use and timing of endoscopy did not account for these differences.