Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Patients with GI bleeding admitted on the weekend have higher death rate

03.03.2009
Studies examine patients with upper GI hemorrhage and GI hemorrhage due to peptic ulcer disease

Previous studies have raised questions regarding differences in quality of care for patients hospitalized on a weekend compared to weekdays. In fact, a growing body of health services research has demonstrated an association between admission to hospitals on the weekend and increased mortality. This "weekend effect" has been attributed to reduced hospital staffing and access to specific intensive treatments and procedures.

Two recent studies published in Clinical Gastroenterology and Hepatology further our understanding of this weekend effect. Clinical Gastroenterology and Hepatology is the official journal of the American Gastroenterological Association (AGA) Institute.

Higher Mortality Reported among Upper GI Bleeding Patients Admitted on the Weekends

Patients with non-variceal upper gastrointestinal hemorrhage (NVUGIH) admitted on the weekend had higher mortality and lower rates of early endoscopy, reports a new study in Clinical Gastroenterology and Hepatology. In addition, patients with acute variceal hemorrhage (AVH) admitted to non-teaching hospitals also had lower utilization of early endoscopy but no difference in survival (hospitals were considered to be teaching hospitals if they had an AMA-approved residency program, were a member of the Council of Teaching Hospitals or had a full time equivalent interns and residents-to-patients ratio of 0.25 or higher).

"Although previous studies have demonstrated differences in outcomes between weekend and weekday admissions, there has been limited analysis focusing on patients with GI bleeding, a common medical emergency that carries significant disease and death," said Ashwin N. Ananthakrishnan, MD, MPH, of the Medical College of Wisconsin and lead author of the study. "The most important finding of our study is the higher mortality among NVUGIH patients admitted on weekends. This finding underscores the need for research into identifying the reasons for the weekend effect and to institute appropriate interventions."

Acute NVUGIH accounts for a majority of upper GI bleeding, while AVH, often complicating cirrhosis and portal hypertension, forms the other large category.

In this cross-sectional study using the Nationwide Inpatient Sample 2004, a total of 28,820 discharges with AVH and 391,119 discharges with NVUGIH were identified through appropriate ICD-9-CM codes. Admissions were considered to be weekend admissions if they were admitted between midnight on Friday through midnight on Sunday.

On analysis, NVUGIH patients admitted on weekends had 22 percent higher adjusted in-hospital mortality and were 36 percent less likely to undergo early endoscopy within one day of hospitalization. There was one excess death for every 143 patients admitted on a weekend. Weekend admission was not predictive of in-hospital mortality in patients with AVH, but was associated with lower likelihood of early endoscopy in non-teaching hospitals. Early endoscopy was associated with significantly shorter hospital stays (NVUGIH: - 1.08 days, AVH: - 2.35 days) and lower hospitalization charges (NVUGIH: -$1,958, AVH - $8,870).

Weekend Patients with Peptic Ulcer-Related UGIB Have Increased Risk of Death

Patients admitted to the hospital on the weekend for peptic ulcer-related hemorrhage have higher mortality and more frequently undergo surgery. Although wait times for endoscopy are prolonged in patients hospitalized on the weekend, this delay does not appear to mediate the weekend effect for mortality, reports another new study also published in Clinical Gastroenterology and Hepatology.

"In addition to increased mortality and higher rates of surgical intervention, patients hospitalized on the weekend experienced greater hospital charges and length of stay than those admitted during weekdays," said Robert P. Myers, MD, of the University of Calgary and lead author of the study. "Future studies should explore alternative processes of care that may mediate these effects, as upper gastrointestinal bleeding represents a considerable clinical and economic burden."

The annual prevalence of upper gastrointestinal bleeding (UGIB) is approximately 170 per 100,000 people and cost is estimated at approximately $750 million. Peptic ulcer disease accounts for 50 to 70 percent of UGIB cases.

Data were extracted from the 1993-2005 U.S. Nationwide Inpatient Sample to identify patients hospitalized for UGIB due to peptic ulceration. Differences in in-hospital mortality between patients admitted on weekends and weekdays were evaluated using logistic regression models, adjusting for patient and clinical factors, including the timing of upper endoscopy.

Between 1993 and 2005, there were 237,412 admissions to 3,166 hospitals for peptic ulcer-related UGIB. Compared with patients admitted on a weekday, those admitted on the weekend had an increased risk of death (3.4 percent versus 3.0 percent), higher rates of surgical intervention (3.4 percent versus 3.1 percent), prolonged hospital stays and increased hospital charges. Although patients hospitalized on the weekend tended to be slightly sicker than patients hospitalized on a weekday (e.g., more likely to be admitted urgently and to have clotting disorders), the observed differences persisted despite adjustment for these patient and hospital-related factors.

Patients admitted on the weekend had a longer mean time to endoscopy (2.21 ± 0.01 versus 2.06 ± 0.01 days) and were less likely to undergo endoscopy on the day of admission (30 percent versus 34 percent). After adjusting for the timing of endoscopy, weekend admission remained an independent predictor of increased mortality.

About the AGA Institute

The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is one of the oldest medical-specialty societies in the U.S. Comprised of two non-profit organizations—the AGA and the AGA Institute—our more than 17,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. The AGA, a 501(c6) organization, administers all membership and public policy activities, while the AGA Institute, a 501(c3) organization, runs the organization's practice, research and educational programs. On a monthly basis, the AGA Institute publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The organization's annual meeting is Digestive Disease Week®, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

About Clinical Gastroenterology and Hepatology

The mission of Clinical Gastroenterology and Hepatology is to provide readers with a broad spectrum of themes in clinical gastroenterology and hepatology. This monthly peer-reviewed journal includes original articles as well as scholarly reviews, with the goal that all articles published will be immediately relevant to the practice of gastroenterology and hepatology.

Alissa Cruz | EurekAlert!
Further information:
http://www.gastro.org
http://www.cghjournal.org

More articles from Studies and Analyses:

nachricht Innovative genetic tests for children with developmental disorders and epilepsy
11.07.2018 | Christian-Albrechts-Universität zu Kiel

nachricht Oxygen loss in the coastal Baltic Sea is “unprecedentedly severe”
05.07.2018 | European Geosciences Union

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Future electronic components to be printed like newspapers

A new manufacturing technique uses a process similar to newspaper printing to form smoother and more flexible metals for making ultrafast electronic devices.

The low-cost process, developed by Purdue University researchers, combines tools already used in industry for manufacturing metals on a large scale, but uses...

Im Focus: First evidence on the source of extragalactic particles

For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.

To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...

Im Focus: Magnetic vortices: Two independent magnetic skyrmion phases discovered in a single material

For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.

Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...

Im Focus: Breaking the bond: To take part or not?

Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.

A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...

Im Focus: New 2D Spectroscopy Methods

Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.

"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Leading experts in Diabetes, Metabolism and Biomedical Engineering discuss Precision Medicine

13.07.2018 | Event News

Conference on Laser Polishing – LaP: Fine Tuning for Surfaces

12.07.2018 | Event News

11th European Wood-based Panel Symposium 2018: Meeting point for the wood-based materials industry

03.07.2018 | Event News

 
Latest News

A smart safe rechargeable zinc ion battery based on sol-gel transition electrolytes

20.07.2018 | Power and Electrical Engineering

Reversing cause and effect is no trouble for quantum computers

20.07.2018 | Information Technology

Princeton-UPenn research team finds physics treasure hidden in a wallpaper pattern

20.07.2018 | Materials Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>