Observational study on the weekend effect and its possible influence on the prognosis of patients with non-variceal gastrointestinal bleeding

Gastrointestinal bleeding is a very serious pathology, with a high rate of morbidity and mortality and a significant impact on hospital resources. Within this type of pathology, non-variceal upper gastrointestinal bleeding (NVUGHB) represents a significant reason for hospital admission, with an incidence of 47 cases per 100,000 inhabitants/year and a mortality rate of around 5.5%, according to data from Spain in 2005. To address this type of bleeding, treatment with haemostatic fibrogastroscopy (FGC) has been established as the best option for management and diagnosis [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24].

Several previous studies on the “weekend” effect in patients with NVUGHB have yielded inconsistent results in relation to mortality, while others found no significant differences. Therefore, the main objective of our study is to evaluate the impact of the time of day (day or night) and day of admission (workday or holiday) on the mortality of patients with NVUGHB after early fibrogastroscopy. This is a retrospective observational study carried out at the Hospital de la Santa Creu i Sant Pau in Barcelona, ​​Spain, with a 24-hour endoscopy unit, with a team trained in gastroenterology.

The study period runs from January 2017 to December 2023, with a final sample of 805 patients.

Comparisons were made between groups: weekdays and weekends, and between daytime and nighttime hours. The main endpoints were: mortality, length of hospital stay and the need for endoscopic treatment.

After careful data collection, the results obtained do not show a statistically significant difference in mortality depending on the time of admission of the patients, as might be believed. However, a higher mortality was observed in admissions on holidays and on night shift (6.3%), and lower in admissions during weekdays and on night shift (2.6%). Furthermore, mortality tended to be lower in patients admitted during working days (3.15%) regardless of the admission shift.

In conclusion, mortality is highly related to the availability of 24-hour fibrogastroscopy and the support of a highly trained team, necessarily balanced across all shifts. Good management of human and technical resources leads to lower mortality and lower healthcare costs.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Mohammed N., Rehman A., Swinscoe M.T., Mundre P., Rembacken B.. 2016; Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience. Endoscopy international open 4 (03): E282
• 2 Gupta A., Agarwal R., Ananthakrishnan A.N.. 2017; “Weekend Effect” in Patients With Upper Gastrointestinal Hemorrhage: A Systematic Review and Meta-analysis. The American journal of gastroenterology
• 3 Bell C.M., Redelmeier D.A.. 2001; Mortality among patients admitted to hospitals on weekends as compared with weekdays. New England Journal of Medicine 345 (09): 663-668
• 4 Gallach, M., Calvet, X., Lanas, A., Feu, F., Ponce, J., Gisbert, J. P.,... ' MUÑOZ11, E. D. 2013 Guía práctica para el manejo de la hemorragia digestiva alta no varicosa Emergencias. 25 (6). 472-481
• 5 Ahmed A., Armstrong M., Robertson I., Morris A.J., Blatchford O., Stanley A.J.. 2015; Upper gastrointestinal bleeding in Scotland 2000-2010: Improved outcomes but a significant weekend effect. World Journal of Gastroenterology: WJG 21 (38): 10890
• 6 Dorn S.D., Shah N.D., Berg B.P., Naessens J.M.. 2010; Effect of weekend hospital admission on gastrointestinal hemorrhage outcomes. Digestive diseases and sciences 55 (06): 1658-1666
• 7 Tufegdzic M., Panic N., Boccia S., Malerba S., Bulajic M., La Vecchia C., Krstic M.. 2014; The weekend effect in patients hospitalized for upper gastrointestinal bleeding: a single-center 10-year experience. European journal of gastroenterology ' hepatology 26 (07): 715-720
• 8 Concha O.P., Gallego B., Hillman K., Delaney G.P., Coiera E.. 2013 Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study BMJ QualSaf, bmjqs-2013.
• 9 Youn Y.H., Park Y.J., Kim J.H., Jeon T.J., Cho J.H., Park H.. 2012; Weekend and nighttime effect on the prognosis of peptic ulcer bleeding. Worldjournal of gastroenterology: WJG 18 (27): 3578
• 10 Jairath V., Kahan B.C., Logan R.F.A., Hearnshaw S.A., Travis S.P.L., Murphy M.F., Palmer K.R.. 2011; Mortality from acute upper gastrointestinal bleeding in the United Kingdom: does it display a “weekend effect”?. The American journal of gastroenterology 106 (09): 1621
• 11 Button L.A., Roberts S.E., Evans P.A., Goldacre M.J., Akbari A., Dsilva R., Williams J.G.. 2011; Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study. Alimentary pharmacology ' therapeutics 33 (01): 64-76
• 12 Shaheen A.A.M., Kaplan G.G., Myers R.P.. 2009; Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clinical Gastroenterology and Hepatology 7 (03): 303-310
• 13 Schmulewitz L., Proudfoot A., Bell D.. 2005; The impact of weekends on outcome for emergency patients. Clinical Medicine 5 (06): 621-625
• 14 Ananthakrishnan A.N., McGinley E.L., Saeian K.. 2009; Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis. Clinical Gastroenterology and Hepatology 7 (03): 296-302
• 15 Tsoi K.K., Chiu P.W., Chan F.K., Ching J.Y., Lau J.Y., Sung J.J.. 2012; The risk of peptic ulcer bleeding mortality in relation to hospital admission on holidays: a cohort study on 8,222 cases of peptic ulcer bleeding. The American journal of gastroenterology 107 (03): 405
• 16 Xia X.F., Chiu P.W.Y., Tsoi K.K.F., Chan F.K.L., Sung J.J.Y., Lau J.Y.W.. 2018; The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts. United European gastroenterology journal 6 (03): 367-381
• 17 Andeliz B., María M.. 2014 Validación multicéntrica de los algoritmos predictivos de la evolución clínica de las hemorragias digestivas altas no varicosas https://ebuah.uah.es/dspace/bitstream/handle/10017/22085/Tesis%20Mercedes%20Burgos.pdf?sequence=3'isAllowed=y
• 18 Charlson M.E., Charlson R.E., Peterson J.C., Marinopoulos S.S., Briggs W.M., Hollenberg J.P.. 2008; The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. Journal of clinical epidemiology 61 (12): 1234-1240
• 19 Wu T.C., Chuah S.K., Chang K.C., Wu C.K., Kuo C.H., Wu K.L., Tai W.C.. 2014 Outcome of holiday and non holiday admission patients with acute peptic ulcer bleeding: a real-world report from southern Taiwan BioMed research international. 2014.
• 20 Murray IA, Dalton HR, Stanley AJ, Ngu JH, Maybin B, Eid M, Lissmann R.. 2017; International prospective observational study of upper gastrointestinal haemorrhage: Does weekend admission affect outcome?. United European Gastroenterology Journal 5 (08): 1082-1089
• 21 Abougergi M.S., Travis A.C., Saltzman J.R.. 2014; Impact of day of admission on mortality and other outcomes in upper GI hemorrhage: a nationwide analysis. Gastrointestinal endoscopy 80 (02): 228-235
• 22 Haas J.M., Gundrum J.D., Rathgaber S.W.. 2012; Comparison of time to endoscopy and outcome between weekend/weekday hospital admissions in patients with upper GI hemorrhage. Wmj 111 (04): 161-5
• 23 RASTA Study Group. De Groot N.L., Bosman J.H., Siersema P.D., van Oijen M.G.H., Bredenoord A.J.. 2012; Admission time is associated with outcome of upper gastrointestinal bleeding: results of a multicentre prospective cohort study. Alimentary pharmacology ' therapeutics 36 (05): 477-484
• 24 Pérez Aisa Á, Nuevo J, López Morante AA, González Galilea Á, Martin de Argila C, Aviñoa Arreal D. et al. Situación actual del manejo de la hemorragia digestiva alta no varicosa en España. Gastroenterol Hepatol [Internet] 2012; 35 (07): 468-75

Publication History

Article published online:
27 March 2025