Sa1097 Analysis of Weekend Admission on Upper Gastrointestinal Bleeding; Is Weekend Effect Demonstrated in Japan?

Abstract

Background and Aims: Whether weekend admission influences the mortality of upper gastrointestinal bleeding(UGIB) remains unclear in Japan. In Europe and North-America, some previous studies identified worse outcomes of weekend admission, however the opposite results were reported from Hong-Kong, Korea and Taiwan. The outcomes may vary considerably between each nation. This study was conducted to assess the weekend effect in patients with UGIB on the basis of a 10-year single-center experience in Japan. Methods and Patients:595 hospitalized patients, who were diagnosed with UGIB between January 2004 and March 2014, were enrolled. We divided those patients into two groups, variceal and nonvariceal UGIB. Bivariate analyses and multivariate logistic regression models were used to evaluate predicting variables of the in-hospital mortality, included patient characteristics, waiting time for endoscopy, and weekend admission. Results: 595 patients consisted of 484 nonvariceal and 111 variceal UGIB. 169 out of 484 Patients with nonvariceal UGIB were weekend admission and had similar mortality rates compared to the weekday group (2.96% vs 2.54%;odds ratio[OR],1.17;confidence interval[CI],0.38-3.63; P=0.79). The waiting time for endoscopy was also not different (9.97 hours versus 9.19 hours, P=0.55). There was no statistical difference in baseline characteristics. In the multivariate logistic regression model, mortality was correlated with Blatchford score ([OR],1.32 per point;[CI],1.05-1.72;P= 0.015) and waiting time to endoscopy ([OR],1.04 per hour;[CI],1.009-1.07; P=0.014). 34 out of 111 Patients with variceal UGIB were weekend admission and had relatively higher mortality rates compared to the weekday group (17.7% vs 10.4%;[OR],1.85;[CI],0.595.81;P=0.29), but not significant. The waiting time for endoscopy was not different (3.35 hours versus 5.3 hours, P =0.09). There was no statistical difference in baseline characteristics, except Child-Pugh scores. Child-Pugh scores of patients with variceal UGIB on weekend admission were significantly higher than those on weekday admission (9.29 vs 8.3; P=0.01). In the multivariate logistic regression model, mortality was correlated with Child-Pugh scores ([OR],1.83 per point;[CI],1.16-3.22; P=0.008). Conclusion:In Japan, quality of care did not appear to differ between week/weekend admission of patients with UGIB and weekend effect was not demonstrated in this study. Patient characteristics and waiting time for endoscopy were correlated with the risk of the in-hospital mortality.