The weekend effect in patients hospitalized for upper gastrointestinal bleeding: a single-center 10-year experience.
OBJECTIVE
This study was conducted to assess the possible weekend effect in patients with upper gastrointestinal bleeding (UGIB) on the basis of a 10-year single-center experience in Serbia.


METHODS
A retrospective analysis of hospital records in the University Clinic 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia, from 2002 to 2012 was conducted. Patients admitted for UGIB were identified, and data on demographic characteristics, symptoms, drug use, alcohol abuse, diagnosis and treatment were collected. Univariate and multivariate logistic regression were used to assess the association between weekend admission and the occurrence of rebleeding and in-hospital mortality.


RESULTS
Analyses included 493 patients. Rebleeding occurred significantly more frequently on weekends (45.7 vs. 32.7%, P=0.004). Weekend admission [odds ratio (OR)=1.78; 95% confidence interval (CI): 1.15-2.74], older age (OR=1.02; 95% CI: 1.00-1.03), and the presence of both melaena and hematemesis (OR=2.29; 95% CI: 1.29-4.07) were associated with the occurrence of rebleeding. No difference between weekend and weekday admissions was observed for the in-hospital mortality rate (6.9% vs. 6.0%, P=0.70). Older age (OR=1.14; 95% CI: 1.08-1.20), presentation with melaena and hematemesis (OR=4.12; 95% CI: 1.56-10.90) and need for surgical treatment (OR=5.16; 95% CI: 1.61-16.53) were significant predictors of all-cause mortality. Patients with nonvariceal bleeding had significantly higher rebleeding rates on weekends (44 vs. 32.3%, P=0.013).


CONCLUSIONS
There was no significant weekend effect in the mortality of patients admitted for UGIB, irrespective of the source of bleeding. Increased attention to older patients presenting with a more severe clinical picture is needed to prolong survival and prevent rebleeding.
aUniversity Clinical-Hospital Center 'Dr Dragisa Misovic-Dedinje' bFaculty of Medicine, University of Belgrade cClinic for Gastroenterology, Clinical Center of Serbia, Belgrade, Serbia dDepartment of Public Health, Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore eIRCCS San Raffaele Pisana, Rome fDepartment of Epidemiology, IRCCS e Istituto di Ricerche Farmacologiche 'Mario Negri', Milan gUniversity Clinical Hospital 'Santa Maria della Misericordia', Udine hDepartment of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy.
Maja
M
Tufegdzic
Nikola
N
Panic
Stefania
S
Boccia
Stefano
S
Malerba
Milutin
M
Bulajic
Carlo
C
La Vecchia
Aleksandra
A
Sljivic
Jasna
J
Trbojevic-Stankovic
Miodrag
M
Krstic
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000628:therapy*; D006396:Hematemesis / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization; D006785:Hospitals, University / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008551:Melena / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D012189:Retrospective Studies