Weekend and nighttime effect on the prognosis of peptic ulcer bleeding

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Authors: Young Hoon Youn ; Yong Jin Park ; Jae Hak Kim ; Tae Joo Jeon ; Jae Hee Cho ; Hyojin Park

MeSH: After-Hours Care* ; 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

Keywords: Early endoscopy ; Nighttime effect ; Peptic ulcer bleeding ; Rebleeding ; Weekend effect

Abstract: AIM: To evaluate whether weekend or nighttime admission 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 January 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 characteristics between the two groups, except for younger age in the weekend group. Most patients (97%) had undergone 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 rebleeding (12% vs 21%, P = 0.030). However, multivariate analysis revealed nighttime admission and a high Rockall score (≥ 6) as significant independent risk factors for rebleeding, rather than weekend admission.

CONCLUSION: Early endoscopy for peptic ulcer bleeding can prevent the weekend effect, and nighttime admission was identified as a novel risk factor for rebleeding, namely the nighttime effect.