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Chang A, Ouejiaraphant C, Pungpipattrakul N, Akarapatima K, Rattanasupar A, Prachayakul V. Effect of holiday admission on clinical outcome of patients with upper gastrointestinal bleeding: A real-world report from Thailand. Heliyon 2022; 8:e10344. [PMID: 36090213 PMCID: PMC9449558 DOI: 10.1016/j.heliyon.2022.e10344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/24/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background Holiday admissions are associated with poorer clinical outcomes compared with non-holiday admissions. However, data remain inconsistent concerning the “holiday effect” for patients with upper gastrointestinal bleeding. This study compared the differences between clinical courses of patients with upper gastrointestinal bleeding who were admitted on holidays and non-holidays in Thailand. Methods We retrospectively reviewed the medical records of patients with upper gastrointestinal bleeding confirmed by endoscopy who were admitted on holidays and non-holidays between January 2016 and December 2017. Mortality, medical resource usage, time to endoscopy, and clinical outcomes were compared between the groups. Results In total, 132 and 190 patients with upper gastrointestinal bleeding were admitted on holidays and non-holidays, respectively. Baseline characteristics, diagnosis of variceal bleeding, and pre-and post-endoscopic scores were not different between the two groups. Patients admitted on non-holidays were more likely to undergo early endoscopy, within 24 h of hospitalization (78.9% vs. 37.9%, p < 0.001), and had a shorter median time to endoscopy (median [interquartile range]: 17 [12–23] vs. 34 [17–56] h, p < 0.001) than those admitted on holidays. No significant differences in in-hospital mortality rate, number of blood transfusions, endoscopic interventions, additional interventions (including angioembolization and surgery), and length of stay were observed. Patients admitted on holidays had increased admission costs than those admitted on non-holidays (751 [495–1203] vs. 660 [432–1028] US dollars, p= 0.033). After adjusting for confounding factors, holiday admission was a predictor of early endoscopy (adjusted odds ratio 0.159; 95% confidence interval, 0096–0.264, p < 0.001), but was not associated with in-hospital mortality or other clinical outcomes. Conclusions Patients with upper gastrointestinal bleeding who were admitted on holidays had a lower rate of early endoscopy, longer time to endoscopy, and higher admission cost than those admitted on non-holidays. Holiday admission was not associated with in-hospital mortality or other clinical outcomes.
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Affiliation(s)
- Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | | | | | - Keerati Akarapatima
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Attapon Rattanasupar
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Varayu Prachayakul
- Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
- Corresponding author.
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Li Y, Han B, Li H, Song T, Bao W, Wang R, Bai Z, Zheng K, Li Q, Guo X, Qi X. Effect of Admission Time on the Outcomes of Liver Cirrhosis with Acute Upper Gastrointestinal Bleeding: Regular Hours versus Off-Hours Admission. Can J Gastroenterol Hepatol 2018; 2018:3541365. [PMID: 30631756 PMCID: PMC6304553 DOI: 10.1155/2018/3541365] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/29/2018] [Accepted: 11/07/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Acute upper gastrointestinal bleeding (AUGIB) is a lethal complication of liver cirrhosis. We aimed to compare the outcomes of patients with liver cirrhosis and AUGIB who were admitted to hospital on regular hours and off-hours. METHODS This retrospective study screened all cirrhotic patients with AUGIB who were admitted to our hospital from January 2010 to June 2014 for the test cohort and from December 2014 to March 2018 for the validation cohort. A 1:1 propensity score matching analysis was performed to adjust the Child-Pugh and MELD scores. In-hospital mortality, 5-day rebleeding rate, length of stay, and total payment were primary outcomes. RESULTS Overall, 826 and 173 patients with liver cirrhosis and AUGIB were included in the test and validation cohorts, respectively. After propensity score matching, 226 and 40 patients were included in the test and validation cohorts, respectively. The overall analysis of the test cohort found significantly higher Child-Pugh score (P=0.006), 5-day rebleeding rate (18.69% versus 10.72%, P=0.001), and total payment (¥25,906.83 versus ¥22,017.42, P<0.001) in patients admitted on off-hours. By contrast, the overall analysis of the validation cohort did not find any difference in Child-Pugh score, 5-day rebleeding, in-hospital mortality, length of stay, or hospital payment between patients admitted on regular hours and off-hours. Similarly, the propensity score matching analyses of both test and validation cohorts found no difference in these primary outcomes between the two groups. CONCLUSIONS Off-hours admission might not be negatively associated with the outcomes of patients with liver cirrhosis and AUGIB.
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Affiliation(s)
- Yingying Li
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
- 2Postgraduate College, Jinzhou Medical University, Jinzhou 121001, China
| | - Bing Han
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
- 2Postgraduate College, Jinzhou Medical University, Jinzhou 121001, China
| | - Hongyu Li
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
| | - Tingxue Song
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
- 3Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, 110840, China
| | - Wenchun Bao
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
- 3Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, 110840, China
| | - Ran Wang
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
| | - Zhaohui Bai
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
- 4Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110840, China
| | - Kexin Zheng
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
- 2Postgraduate College, Jinzhou Medical University, Jinzhou 121001, China
| | - Qianqian Li
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
- 5Postgraduate College, Dalian Medical University, Dalian 116044, China
| | - Xiaozhong Guo
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
| | - Xingshun Qi
- 1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, 110840, China
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"Weekend Effect" in Patients With Upper Gastrointestinal Hemorrhage: A Systematic Review and Meta-analysis. Am J Gastroenterol 2018; 113:13-21. [PMID: 29134968 DOI: 10.1038/ajg.2017.430] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES "Weekend effect" refers to worse outcomes among patients presenting to the hospital on weekends or holidays. We performed a systematic review and meta-analysis of observational studies assessing the impact of the "weekend effect" in patients with upper gastrointestinal hemorrhage (UGIH). METHODS We searched key bibliographic databases using keywords and MeSH terms related to gastrointestinal hemorrhage and "weekend effect". Our primary analysis evaluated mortality in patients with UGIH who were hospitalized on the weekend or after-hours compared with a weekday. Secondary outcomes included need for definitive therapy and length of hospital stay. Relevant data were extracted and meta-analyses were performed using random effects model. Subgroup sensitivity analyses were also performed to assess the effects of key variables. RESULTS A total of 21 of 224 identified studies met inclusion criteria. Overall, there was no association between weekend admission and mortality among patients with UGIH (Odds Ratio (OR): 1.06; 95% confidence interval (CI): 0.99-1.14). However, meta-analysis using only the nine studies that did not report having a weekend rounder showed a significant increase in mortality (OR: 1.12; 95% CI: 1.07-1.17). There was no effect of weekend admission on any of our secondary outcomes. CONCLUSIONS Current evidence suggests that weekend admission is associated with significant increase in mortality in patients with non-variceal UGIH but no difference in mortality was noted in patients with variceal UGIH. Our findings are relevant to policymakers, practitioners and providers who should ensure the creation of consistent quality and access to care throughout the week.
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Khamaysi I, Gralnek IM. Nonvariceal Upper Gastrointestinal Bleeding: Timing of Endoscopy and Ways to Improve Endoscopic Visualization. Gastrointest Endosc Clin N Am 2015; 25:443-8. [PMID: 26142030 DOI: 10.1016/j.giec.2015.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Upper gastrointestinal (UGI) endoscopy is the cornerstone of diagnosis and management of patients presenting with acute UGI bleeding. Once hemodynamically resuscitated, early endoscopy (performed within 24 hours of patient presentation) ensures accurate identification of the bleeding source, facilitates risk stratification based on endoscopic stigmata, and allows endotherapy to be delivered where indicated. Moreover, the preendoscopy use of a prokinetic agent (eg, i.v. erythromycin), especially in patients with a suspected high probability of having blood or clots in the stomach before undergoing endoscopy, may result in improved endoscopic visualization, a higher diagnostic yield, and less need for repeat endoscopy.
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Affiliation(s)
- Iyad Khamaysi
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Israel; Interventional Endoscopy Unit, Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Ian M Gralnek
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Israel; The Institute of Gastroenterology and Liver Diseases, Ha'Emek Medical Center, Afula, Israel.
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