title: Weekend Admission for Acute Cholangitis Does Not Adversely Impact Clinical or Endoscopic Outcomes.
abstract: BACKGROUND
  Acute cholangitis (AC) requires prompt diagnosis and treatment for optimal management.
  
  
  OBJECTIVE
  To examine whether a putative "weekend effect" impact outcomes of patients hospitalized for AC.
  
  
  METHODS
  We conducted a retrospective study of patients admitted with AC between 2009 and 2012. After excluding those not meeting Tokyo consensus criteria for AC, the cohort was categorized into weekend (Saturday-Sunday) and weekday (Monday-Friday) hospital admission and endoscopic retrograde cholangiography (ERC) groups. Primary outcome was length of stay (LOS); secondary outcomes included ERC performance, organ failure, and mortality. Groups were compared with Chi-square and t tests; predictors of LOS were assessed with linear regression.
  
  
  RESULTS
  The cohort consisted of 181 patients (mean age 63.1 years, 62.4 % male). Choledocholithiasis was the most common etiology of AC (29.4 %). Fifty-two patients (28.7 %) were admitted on a weekend and 129 (71.3 %) on a weekday. One hundred forty-one patients (78 %) underwent ERC, of which 120 (85 %) were on a weekday. There were no significant differences in baseline characteristics, LOS, proportion undergoing ERC, time to ERC, organ failure, or mortality between weekend and weekday admission groups. Similarly, there were no significant differences between weekend and weekday ERC groups. In multivariate analyses, international normalized ratio (p < 0.01) and intensive care unit triage (p < 0.01) were independent predictors of LOS, whereas weekend admission (p = 0.23) and weekend ERC (p = 0.74) were not.
  
  
  CONCLUSIONS
  Weekend admission and weekend ERC do not negatively impact outcomes of patients hospitalized with acute cholangitis at a tertiary care center. Further studies, particularly in centers with less weekend resources or staffing, are indicated.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.|Center for Endoscopic Education, Innovation, and Training, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Tabibian
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Ju Dong
authors.initials: JD
authors.lastname: Yang
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.|Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Sunanda V
authors.initials: SV
authors.lastname: Kane
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Felicity B
authors.initials: FB
authors.lastname: Enders
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. gostout.christopher@mayo.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
mesh_terms: D000208:Acute Disease; D039602:After-Hours Care / Q000592:standards; D000368:Aged; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000592:standards; D002761:Cholangitis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D017051:Hospice Care; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D010343:Patient Admission; D010351:Patient Discharge; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Biliary tract diseases; Endoscopic treatment; Length of stay; Quality assurance