Management of upper gastrointestinal bleeding – Is there a “weekend or night” effect?

Introduction: Upper gastrointestinal bleeding (UGIB) remains a common problem. Early endoscopy has been proven to shorten length of stay, increase efficiency of care, lower rates of surgery and reduce the needs for transfusion. Our aim is to evaluate the practice of urgent (4h) and early (< 24h) endoscopy during weekdays and weekend, daytime and nighttime.

Patients & methods: the retrospective study reviewed 402 patients (range 22 – 93ys, male gender predominated 4:1) admitted to our department January 1, 2011 through December 31, 2012 with the primary diagnosis of UGIB. 4% of the patients were in in-hospital patient status, the other were admitted via emergency department. Most patients (98%) underwent early endoscopy (within 24 hours) regardless of weekend or nighttime admission. Endoscopy was performed within 4 hours in more than 50% of the pts. The first endoscopy revealed the source of bleeding in 85% of the patients. The time to endoscopy was slightly shorter at the weekend (mean time: 3.5 ± 2.5h vs. 5.0 ± 3.0h), although the difference is not significant. When time to endoscopy was compared between the daytime and the nighttime examinations on pts with UGIB, it was significantly shorter in case of nighttime bleedings group (5.5h during the day and 3.5h by night). The rebleeding after endoscopic treatment or the unsuccessfull treatment was higher at the weekend, although the difference is not significant. After unsuccessful endoscopic treatment need for surgical intervention was limited to 6% of the patients. The mean time interval between endoscopy to the operation room was higher during daytime (50 min ± 25 min vs. 80 min ± 65 min), secondary to the overladen capacity of operation rooms. Conclusion: Most studies have hypothesized that the weekend and night effect is attributable to reduced hospital staffing access to specific intensive treatments and procedures. We did not observe this effect in our department in patients with UGIB secondary to our well-organized duty system, enthusiastic colleagues and formal out-of-hours emergency endoscopy services.