Review | Published:

“Weekend Effect” in Patients With Upper Gastrointestinal Hemorrhage: A Systematic Review and Meta-analysis

The American Journal of Gastroenterology volume 113, pages 1321 (2018) | Download Citation

Abstract

Objectives:

“Weekend effect” refers to worse outcomes among patients presenting to the hospital on weekends or holidays. We performed a systematic review and meta-analysis of observational studies assessing the impact of the “weekend effect” in patients with upper gastrointestinal hemorrhage (UGIH).

Methods:

We searched key bibliographic databases using keywords and MeSH terms related to gastrointestinal hemorrhage and “weekend effect”. Our primary analysis evaluated mortality in patients with UGIH who were hospitalized on the weekend or after-hours compared with a weekday. Secondary outcomes included need for definitive therapy and length of hospital stay. Relevant data were extracted and meta-analyses were performed using random effects model. Subgroup sensitivity analyses were also performed to assess the effects of key variables.

Results:

A total of 21 of 224 identified studies met inclusion criteria. Overall, there was no association between weekend admission and mortality among patients with UGIH (Odds Ratio (OR): 1.06; 95% confidence interval (CI): 0.99–1.14). However, meta-analysis using only the nine studies that did not report having a weekend rounder showed a significant increase in mortality (OR: 1.12; 95% CI: 1.07–1.17). There was no effect of weekend admission on any of our secondary outcomes.

Conclusions:

Current evidence suggests that weekend admission is associated with significant increase in mortality in patients with non-variceal UGIH but no difference in mortality was noted in patients with variceal UGIH. Our findings are relevant to policymakers, practitioners and providers who should ensure the creation of consistent quality and access to care throughout the week.

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Author information

Affiliations

  1. ProCare Gastroenterology, Odessa, Texas, USA

    • Ashutosh Gupta
  2. North Mississippi Medical Center, Tupelo, Mississippi, USA

    • Rajender Agarwal
  3. Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA

    • Ashwin N Ananthakrishnan

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Competing interests

Guarantor of the article: Ashutosh Gupta, MD.

Specific author contributions: A.G. and R.A.: study concept and design; A.G.: acquisition and analysis of the data; A.G. and R.A.: interpretation of the data; R.A.: drafting of the manuscript; A.G. and A.N.A.: critical revision of the manuscript. All authors approved the final draft submitted.

Financial support: None.

Potential competing interests: None.

Corresponding author

Correspondence to Ashutosh Gupta.

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DOI

https://doi.org/10.1038/ajg.2017.430

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg