The Burrill Report

A growing body of health services research has pointed to an association between admission to hospitals on the weekend and increased mortality. This so-called ‘weekend effect” has been attributed to reduced hospital staffing and access to specific intensive treatments and procedures. Two recent studies published in the journal Clinical Gastroenterology and Hepatology build the case for this weekend effect.

In one study, researchers found that patients with non-variceal upper gastrointestinal hemorrhage admitted on the weekend had higher mortality and lower rates of early endoscopy. In addition, patients with acute variceal hemorrhage admitted to non-teaching hospitals also had lower utilization of early endoscopy but no difference in survival.

“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,” says Ashwin Ananthakrishnan of the Medical College of Wisconsin and lead author of the study.  He says the finding of higher mortality rates for patients suffering from non-variceal upper gastrointestinal hemorrhage on the weekend underscores the need for research into identifying the reasons for the weekend effect and to institute appropriate interventions.

The researchers data from a cross-sectional study using the Nationwide Inpatient Sample 2004, a total of 28,820 discharges with acute variceal hemorrhage and 391,119 discharges with non-variceal upper gastrointestinal hemorrhage were identified. Admissions were considered to be weekend admissions if they were admitted between midnight on Friday through midnight on Sunday.

On analysis, non-variceal upper gastrointestinal hemorrhage 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 acute variceal hemorrhage, but was associated with lower likelihood of early endoscopy in non-teaching hospitals. Early endoscopy was associated with significantly shorter hospital stays and lower hospitalization charges.

A separate study published in Clinical Gastroenterology and Hepatology found 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, researchers from the Univeristy of Calgary report.

“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,” says Robert Myers 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.”

March 05, 2009
http://www.burrillreport.com/article-the_weekend_effect.html