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

Xia, Xianfeng; Chiu, Philip Wai Yan; Tsoi, Kelvin K.F.; Chan, Francis K.L.; Sung, Joseph J.Y.; Lau, James Y.

doi:10.1177/2050640617732651

Cited by 17 publications

(18 citation statements)

References 27 publications

(231 reference statements)

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“…These findings are consistent with those of the United Kingdom UGIB audit which did not show a difference in fatality or patients presenting at weekends compared to weekdays 5 . However, several studies including a previous Scottish study have suggested a ‘weekend effect’, reporting higher case‐fatality in patients admitted at weekends 18,20,33‐35 . One possible explanation for the findings in our current study is that both staffing and resources at weekends have improved.…”

Section: Discussionsupporting

confidence: 91%

Upper gastrointestinal bleeding in Scotland 2000‐2015: trends in demographics, aetiology and outcomes

Chaudhary

Mackay

Pell

et al. 2020

Aliment Pharmacol Ther

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SummaryBackgroundUpper gastrointestinal bleeding (UGIB) remains a common cause of presentation and admission to hospital in the UK, with the incidence in Scotland one of the highest in the world.AimsTo investigate the difference in demographics, deprivation quintiles, aetiology of bleeding and clinical outcomes in patients presenting with UGIB to hospitals across Scotland over a 16‐year periodMethodsData were collected using the National Data Catalogue and analysed retrospectively using the National Safe Haven.ResultsWe included 129 404 patients. The annual number of patients presenting with UGIB remained similar over the 16‐year period. Mean age at admission increased from 59.2 to 61.4 years. There was a significant drop in variceal bleeding over time from 2.2% to 1.7% (P < 0.001). The incidence of UGIB was highest in the more deprived quintiles. There was a significant decrease in 30‐day case‐fatality from 10.1% in 2000 to 7.9% in 2015 (P < 0.001), which was observed across all deprivation quintiles. Mean length of stay fell from 3.9 to 2.1 days. There was no difference in 30‐day case‐fatality or mean length of stay between patients presenting on weekdays or at weekends.ConclusionsIn this national study, we demonstrated that case‐fatality and mean length of stay after presentation with UGIB in Scotland has fallen over the past 16 years, despite a rise the in mean age of patients. There is a positive correlation between the incidence of UGIB and deprivation. We found no evidence of worse outcomes among patients presenting at weekends.

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Section: Discussionsupporting

confidence: 91%

Upper gastrointestinal bleeding in Scotland 2000‐2015: trends in demographics, aetiology and outcomes

Chaudhary

Mackay

Pell

et al. 2020

Aliment Pharmacol Ther

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“…A meta-analysis [16] found that off-hours admission was not associated with a higher risk of rebleeding rate (OR=1.06, 95%CI=0.83-1.35, and P=0.66) and longer length of stay (WMD 0.06 day, 95%CI=-0.30 - -0.42, P=0.747). These previous findings were consistent with our results regarding 5-day rebleeding rate and length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…Two of the published meta-analyses [16, 17] demonstrated a significant weekend effect on the mortality in patients with nonvariceal UGIB, but not those with variceal bleeding. This finding seemed to be consistent with our results regarding mortality.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, others suggested no significant difference in the mortality between patients admitted during weekends and weekdays [10–15]. A meta-analysis [16] reported that off-hours admission was significantly associated with an increased mortality and less timely endoscopy in patients with nonvariceal bleeding but not those with variceal bleeding. More recently, another meta-analysis [17] also had similar results.…”

Section: Introductionmentioning

confidence: 99%

“…First, meta-analyses have shown that geographical variation leads to different weekend effect on outcomes [16, 17]. A study, which included 571 patients suspected with upper gastrointestinal bleeding (UGIB) from 8 participating hospitals in the Netherlands [11], reported that patients admitted on weekends had higher mortality and rebleeding rate than those admitted on weekdays.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of Admission Time on the Outcomes of Liver Cirrhosis with Acute Upper Gastrointestinal Bleeding: Regular Hours versus Off-Hours Admission

Han

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims Acute upper gastrointestinal bleeding (AUGIB) is a lethal complication of liver cirrhosis. We aimed to compare the outcomes of patients with liver cirrhosis and AUGIB who were admitted to hospital on regular hours and off-hours. Methods This retrospective study screened all cirrhotic patients with AUGIB who were admitted to our hospital from January 2010 to June 2014 for the test cohort and from December 2014 to March 2018 for the validation cohort. A 1:1 propensity score matching analysis was performed to adjust the Child-Pugh and MELD scores. In-hospital mortality, 5-day rebleeding rate, length of stay, and total payment were primary outcomes. Results Overall, 826 and 173 patients with liver cirrhosis and AUGIB were included in the test and validation cohorts, respectively. After propensity score matching, 226 and 40 patients were included in the test and validation cohorts, respectively. The overall analysis of the test cohort found significantly higher Child-Pugh score (P=0.006), 5-day rebleeding rate (18.69% versus 10.72%, P=0.001), and total payment (¥25,906.83 versus ¥22,017.42, P<0.001) in patients admitted on off-hours. By contrast, the overall analysis of the validation cohort did not find any difference in Child-Pugh score, 5-day rebleeding, in-hospital mortality, length of stay, or hospital payment between patients admitted on regular hours and off-hours. Similarly, the propensity score matching analyses of both test and validation cohorts found no difference in these primary outcomes between the two groups. Conclusions Off-hours admission might not be negatively associated with the outcomes of patients with liver cirrhosis and AUGIB.

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Adhesive Hemostatic Hydrogel with Ultrafast Gelation Arrests Acute Upper Gastrointestinal Hemorrhage in Pigs

Xia

Wang

et al. 2021

Adv Funct Materials

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Upper gastrointestinal (GI) hemorrhage is a common clinical emergency worldwide. Endoscopic hemostasis is the current first line treatment. Nevertheless, for patients with severe active bleeding and challenging anatomy, endoscopic management can be still difficult and usually requires a higher level of surgical expertise. A simple and effective method of endoscopic hemostasis is therefore in acute clinical demand. Herein a hemostatic hybrid hydrogel comprised of hyaluronic acid and polyethylene glycol stabilized by thiourea-catechol coupling and disulfide bonds is reported. The hybrid hydrogels exhibit enhanced mechanical properties, short gelation time, and good blood clotting ability compared with fibrin gels. The in vivo hemostatic efficacy is confirmed in a rat model of arterial bleeding, in which the rapid gelation of hybrid hydrogels after topical application effectively arrests blood loss with no rebleeding occurring during resuscitation when blood pressure approximately recovers to normal. A large animal study further demonstrates the efficacy of hybrid hydrogels to achieve endoscopic hemostasis against upper GI hemorrhage in pigs. Follow-up observations show that the hybrid hydrogels can remain adherent at the bleeding wound for 48 h, indicating the sustained hemostatic function in vivo. Collectively, this work demonstrates a promising hemostatic hydrogel for endoscopic hemostasis in upper GI hemorrhage.

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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

Cited by 17 publications

References 27 publications

Upper gastrointestinal bleeding in Scotland 2000‐2015: trends in demographics, aetiology and outcomes

Upper gastrointestinal bleeding in Scotland 2000‐2015: trends in demographics, aetiology and outcomes

Effect of Admission Time on the Outcomes of Liver Cirrhosis with Acute Upper Gastrointestinal Bleeding: Regular Hours versus Off-Hours Admission

Adhesive Hemostatic Hydrogel with Ultrafast Gelation Arrests Acute Upper Gastrointestinal Hemorrhage in Pigs

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