Original article Clinical endoscopy| Volume 84, ISSUE 3, P416-423, September 2016

In-hospital weekend outcomes in patients diagnosed with bleeding gastroduodenal angiodysplasia: a population-based study, 2000 to 2011

Published:March 10, 2016DOI:https://doi.org/10.1016/j.gie.2016.02.046

      Background and Aims

      GI angiodysplastic (GIAD) lesions are an important cause of blood loss throughout the GI tract, particularly in elderly persons. The aim of this study was to determine whether mortality rates in patients with GIAD were higher for weekend compared with weekday hospital admissions.


      We performed a retrospective study using the National Inpatient Sample database from 2000 to 2011 including inpatients with an International Classification of Diseases, Ninth Revision, Clinical Modification code for gastrointestinal GIAD (code 537.82 or 537.83). We assessed rates of delayed endoscopy (examinations performed >24 hours after admission), intensive care unit (ICU) admissions, and in-hospital mortality rates. Bivariate and multivariate logistic regression analyses were performed to identify risk factors for mortality.


      There were 85,971 discharges for GIAD between 2000 and 2011, of which 69,984 (81%) were weekday hospital admissions and 15,987 (19%) were weekend admissions. Patients with weekend versus weekday admissions were more likely to undergo delayed endoscopic examination (35% vs 26%, P ≤ .0001). Mortality rates were higher for patients with weekend admissions (2% vs 1%, P = .0002). The adjusted odds ratio (aOR) for inpatient mortality associated with weekend admissions was elevated (2.4; 95% confidence interval [CI], 1.5-3.9; P = .0005). Rates of delayed endoscopic examinations were lower in patients with higher socioeconomic status (aOR = 0.77; 95% CI, 0.68-0.88). ICU admission rates were higher for weekend compared with weekday admissions (8% vs 6%, P = .004). The presence of a delayed endoscopic examination was associated with an increased length of stay of 1.3 days (95% CI, 1.2-1.4 days).


      Weekend admissions for angiodysplasia were associated with higher odds of mortality, ICU admissions, higher rates of delayed endoscopic procedures, longer lengths of stay, and higher hospital charges.


      aOR (adjusted odds ratio), CDI (Charlson/Deyo Index), CI (confidence interval), GDA (gastroduodenal angiodysplasia), GIAD (GI angiodysplasia), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), ICU (intensive care unit), LOS (length of stay), NIS (National Inpatient Sample), SD (standard deviation), SES (socioeconomic status)
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        • Longstreth G.F.
        Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.
        Am J Gastroenterol. 1997; 92: 419-424
        • Boley S.J.
        • Sammartano R.
        • Adams A.
        • et al.
        On the nature and etiology of vascular ectasias of the colon: degenerative lesions of aging.
        Gastroenterology. 1977; 72: 650-660
        • Bollinger E.
        • Raines D.
        • Saitta P.
        Distribution of bleeding gastrointestinal angioectasias in a Western population.
        World J Gastroenterol. 2012; 18: 6235-6239
        • Clouse R.E.
        • Costigan D.J.
        • Mills B.A.
        • et al.
        Angiodysplasia as a cause of upper gastrointestinal bleeding.
        Arch Intern Med. 1985; 145: 458-461
        • Myers R.P.
        • Kaplan G.G.
        • Shaheen A.A.M.
        The effect of weekend versus weekday admission on outcomes of esophageal variceal hemorrhage.
        Can J Gastroenterol. 2009; 23: 495-501
      1. Overview of the National (Nationwide) Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) website. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed July 12, 2015.

        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Gunnlaugsson O.
        Angiodysplasia of the stomach and duodenum.
        Gastrointest Endosc. 1985; 31: 251-254
        • Fleischer D.
        Etiology and prevalence of severe persistent upper gastrointestinal bleeding.
        Gastroenterology. 1983; 84: 538-543
        • Andikipolou P.
        • Nikolopulou V.
        • Dougenis D.
        Emergency endoscopy in upper gastrointestinal hemorrhage: evaluation of 855 patients.
        JR Coll Surg Edinb. 1988; 33: 121-123
        • Zuckerman G.
        • Benitez J.
        A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding.
        Am J Gastroenterol. 1992; 87: 62-66
        • Foutch P.G.
        Angiodysplasia of the gastrointestinal tract.
        Am J Gastroenterol. 1993; 88: 807-818
        • Shaheen A.A.
        • Kaplan G.G.
        • Myers R.P.
        Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease.
        Clin Gastroenterol Hepatol. 2009; 7: 303-310
        • Dorn S.D.
        • Shah N.D.
        • Berg B.P.
        • et al.
        Effect of weekend hospital admission on gastrointestinal hemorrhage outcomes.
        Dig Dis Sci. 2010; 55: 1658-1666
        • Abougergi M.S.
        • Travis A.C.
        • Saltzman J.R.
        Impact of day of admission on mortality and other outcomes in upper GI hemorrhage: a nationwide analysis.
        Gastrointest Endosc. 2014; 80: 228-235
        • Kumar G.
        • Deshmukh A.
        • Sakhuja A.
        • et al.
        Acute myocardial infarction: a national analysis of the weekend effect over time.
        J Am Coll Cardiol. 2015; 65: 217-218
        • Vreeburg E.M.
        • Snel P.
        • de Bruijne J.W.
        • et al.
        Acute upper gastrointestinal bleeding in the Amsterdam area: incidence, diagnosis, and clinical outcome.
        Am J Gastroenterol. 1997; 92: 236-243
        • Lin H.J.
        • Wang K.
        • Perng C.L.
        • et al.
        Early or delayed endoscopy for patients with peptic ulcer bleeding: a prospective randomized study.
        J Clin Gastroenterol. 1996; 22: 267-271
        • Cooper G.S.
        • Chak A.
        • Way L.E.
        • et al.
        Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay.
        Gastrointest Endosc. 1999; 49: 145-152
        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • et al.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139
        • Cooper G.S.
        • Chak A.
        • Lloyd L.E.
        • et al.
        The accuracy of diagnosis and procedural codes for patients with upper GI hemorrhage.
        Gastrointest Endosc. 2000; 51: 423-426
        • Kaplan G.G.
        • Hubbard J.
        • Panaccione R.
        • et al.
        Risk of comorbidities on postoperative outcomes in patients with inflammatory bowel disease.
        Arch Surg. 2011; 46: 959-964
        • Quintero E.
        • Pique J.M.
        • Bombi J.A.
        • et al.
        Gastric mucosal vascular ectasias causing bleeding in cirrhosis: a distinct entity associated with hypergastrinemia and low serum levels of pepsinogen I.
        Gastroenterology. 1987; 93: 1054-1061