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Outcomes in lower GI bleeding comparing weekend with weekday admission

  • Author Footnotes
    ∗ Drs Li and Stein contributed equally to this article.
    Brian Li
    Footnotes
    ∗ Drs Li and Stein contributed equally to this article.
    Affiliations
    Department of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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  • Author Footnotes
    ∗ Drs Li and Stein contributed equally to this article.
    Daniel J. Stein
    Footnotes
    ∗ Drs Li and Stein contributed equally to this article.
    Affiliations
    Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Jeffrey Schwartz
    Affiliations
    Department of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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  • Megan Lipscey
    Affiliations
    Department of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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  • Joseph D. Feuerstein
    Correspondence
    Reprint requests: Joseph D. Feuerstein, 110 Francis St, 8e Gastroenterology, Boston, MA 02215.
    Affiliations
    Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Li and Stein contributed equally to this article.
Published:April 21, 2020DOI:https://doi.org/10.1016/j.gie.2020.04.031

      Background and Aims

      Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospitalization potentially requiring urgent intervention, which may not be readily available at weekends and off-hours. The aim of this study was to examine the association between weekend admission for LGIB and mortality, time to colonoscopy, length of stay, and hospital charges.

      Methods

      The 2016 U.S. National Inpatient Sample (NIS) dataset was queried for admissions with a primary diagnosis of LGIB. Outcomes for weekend versus weekday admissions were compared using survey-adjusted chi-squared or bivariate correlation. Multivariable regression was then used to compare primary outcomes adjusting for the Elixhauser mortality score (a validated measure of comorbidities), colonoscopy, transfusion, shock, and hospital type.

      Results

      An estimated 124,620 patients were admitted for LGIB in 2016. Comparing weekend with weekday admissions, there was no difference in unadjusted mortality (0.9% vs 1.0%, P = .636). Colonoscopy within the first day (28.6% vs 23.0%, P < .001) and transfusion (34.0% vs 31.5%, P < .001) were more common with weekday admissions; no differences in colonoscopy rate (60.7% vs 60.9%, P = .818), angiography rate (2.7% vs 2.7%, P = .976), mean days to colonoscopy (2.0 vs 2.0, P = .233), or length of stay (4.2 vs 4.1 days, P = .068) were seen. There was no difference in multivariable adjusted mortality rates (odds ratio, 1.11; 95% confidence interval, 0.81-1.54; P = .495) based on the above factors.

      Conclusions

      Early colonoscopy (within the first day) is more common for weekday admissions, but overall outcomes are not affected by weekend admission for LGIB compared with weekday admissions.

      Abbreviations:

      LGIB (lower gastrointestinal bleeding), NIS (National Inpatient Sample), UGIB (upper gastrointestinal bleeding)
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      Linked Article

      • Is lower GI bleeding on weekend admissions associated with worse outcomes?
        Gastrointestinal EndoscopyVol. 92Issue 5
        • Preview
          We have read the recent article on the "weekend effect" phenomenon for lower GI bleeding (LGIB) by Li et al.1 The authors demonstrated that the outcomes of weekend admissions were not significantly different from those of weekday admissions regarding mortality, length of stay, or charge, using a large retrospective billing-based dataset with an estimated 12,462 inpatients for LGIB. As they discussed as a limitation, this dataset does not allow for clinical information, including antithrombogenic drug use or blood pressure.
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