Weekend versus Weekday Admission and Outcomes for Hospitalizations Due to Hemorrhagic Peptic Ulcer Disease: An Insight From National Data

Abstract

Introduction: Previous studies have identified a weekend effect in outcomes of patients with various medical conditions including upper gastrointestinal hemorrhage (UGIH) suggesting worse outcomes for weekend admissions. The aim of our study was to analyze if so called ‘weekend effect' still exist in a rapidly improving health care delivery system for UGIH hospitalizations. Methods: We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002-2014. Adult hospitalizations for UGIB caused by peptic ulceration were identified by previously validated ICD-9-CM codes as primary diagnosis. Non- elective admissions through emergency department were included in final cohort. Primary outcomes were in-hospital mortality and discharge to facilty. Secondary outcomes were mean time to Endoscopy and total length of stay (LOS). Differences in outcomes for weekends and weekdays admissions were analysed by multivariate higherechial logistic regression models, adjusting for patient, hospital and other relevant clinical factors. Results: Between 2002 and 2014, there were 1,143,782 admissions for peptic ulcer-related UGIB out of which 293,880 (25%) were admitted during weekend. In the univariate analysis weekend admissions had an slightly increased in-hospital mortality ( 2.5% vs 2.3%, p<0.01), discharge to facility (15.73% Vs. 15.50%, p<0.01). Similarly mean timing of endoscopy was slighly delayed in the patients admitted during the weekend (1.4 Days Vs. 1.2 Days, P<0.01) which eventually led to the increase in LOS among the weekend patients (4.79 Vs. 4.72, P<0.001). However after adjusting with confounders, multivariate analysis conlcuded that there was no difference in the in-hospital mortality between weekend and weekday admissions (aOR 1.07; 95% confidence interval [CI], 0.99-1.14,P=0.05) and as well as discharge to facility (aOR, 1.01; 95% CI, 0.98-1.04,P=0.24). Conclusion: Although in the previous studies it was concluded that patients admitted to hospital on the weekend for peptic ulcer-related hemorrhage have higher mortality, our study from the nationwide data suggests no difference in mortality and adverse discharges based on the day of admission, although wait times for endoscopy are prolonged in patients hospitalized on the weekend.