Weekend and nighttime effect on the prognosis of peptic ulcer bleeding

• Published in: World journal of gastroenterology : WJG Vol. 18; no. 27; pp. 3578 - 3584
• Main Authors: Youn, Young Hoon, Park, Yong Jin, Kim, Jae Hak, Jeon, Tae Joo, Cho, Jae Hee, Park, Hyojin
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 21-07-2012
• Subjects: After-Hours Care; Brief; Chi-Square Distribution; Emergency Service, Hospital; Female; Health Services Accessibility; Hemostasis, Endoscopic - adverse effects; Hemostasis, Endoscopic - mortality; Hospital Mortality; Humans; Length of Stay; Linear Models; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Peptic Ulcer Hemorrhage - pathology; Peptic Ulcer Hemorrhage - therapy; Recurrence; Reoperation; Republic of Korea; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; 危险因素; 多变量分析; 数据收集; 死亡率; 消化性; 溃疡出血; 胃镜检查; 预后; Republic of Korea; Peptic ulcer bleeding; Weekend effect; Nighttime effect; Rebleeding; Early endoscopy
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i27.3578

AIM： To evaluate whether weekend or nighttime ad- mission affects prognosis of peptic ulcer bleeding despite early endoscopy. METHODS： Retrospective data collection from four referral centers, all of which had a formal out-of-hours emergency endoscopy service, even at weekends. A total of 388 patients with bleeding peptic ulcers who were admitted via the emergency room between Janu- ary 2007 and December 2009 were enrolled. Analyzed parameters included time from patients＇ arrival until endoscopy, mortality, rebleeding, need for surgery and length of hospital stay.RESULTS： The weekday and weekend admission groups comprised 326 and 62 patients, respectively. There were no significant differences in baseline characteris- tics between the two groups, except for younger age in the weekend group. Most patients （97%） had under- gone early endoscopy, which resulted in a low mortality rate regardless of point of presentation （1.8% overall vs 1.6% on the weekend）. The only outcome that was worse in the weekend group was a higher rate of re- bleeding （12% vs 21%, P = 0.030）. However, multivari- ate analysis revealed nighttime admission and a high Rockall score （≥6） as significant independent risk fac- tors for rebleeding, rather than weekend admission. CONCLUSION： Early endoscopy for peptic ulcer bleed- ing can prevent the weekend effect, and nighttime ad- mission was identified as a novel risk factor for rebleed- ing, namely the nighttime effect.