Abstract
BackgroundLittle has been reported on mortality following admissions at weekends for many gastrointestinal (GI) disorders. The aim was to establish whether GI disorders are susceptible to increased mortality following unscheduled admission on weekends compared with weekdays.MethodsRecord linkage was undertaken of national administrative inpatient and mortality data for people in England and Wales who were hospitalized as an emergency for one of 19 major GI disorders.ResultsThe study included 2 254 701 people in England and 155 464 in Wales. For 11 general surgical and medical GI disorders there were little, or no, significant weekend effects on mortality at 30 days in either country. There were large consistent weekend effects in both countries for severe liver disease (England: 26·2 (95 per cent c.i. 21·1 to 31·6) per cent; Wales: 32·0 (12·4 to 55·1 per cent) and GI cancer (England: 21·8 (19·1 to 24·5) per cent; Wales: 25·0 (15·0 to 35·9) per cent), which were lower in patients managed by surgeons. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43·3 per cent in England and 51·4 per cent in Wales) and GI cancer (by 44·6 and 52·8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons.DiscussionThere is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. The findings for severe liver disease may suggest a lack of specialist hepatological resources. For cancers, reduced availability of end-of-life care in the community at weekends may be the cause.
Highlights
A weekend effect of increased mortality for admissions on weekends, compared with normal weekdays, has been investigated extensively in recent years[1,2,3]
Other than several reports on the weekend effect for upper GI bleeding[3,14,15,16,17,18,19,20,21], and two reports from Australia[12] and Canada[9] on the weekend effect for some GI cancers, little has been reported for other GI conditions
The primary objective of this study was to establish whether a wide range of major GI disorders are susceptible to the so-called weekend effect on mortality, following unscheduled hospital admission
Summary
A weekend effect of increased mortality for admissions on weekends, compared with normal weekdays, has been investigated extensively in recent years[1,2,3]. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43⋅3 per cent in England and 51⋅4 per cent in Wales) and GI cancer (by 44⋅6 and 52⋅8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons. Discussion: There is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Reduced availability of end-of-life care in the community at weekends may be the cause
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