Meta-Analysis
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World J Meta-Anal. May 26, 2014; 2(2): 29-35
Published online May 26, 2014. doi: 10.13105/wjma.v2.i2.29
Weekday vs weekend endoscopy: Is there a true difference in patient outcomes? A meta-analysis
Alisha M Hinds, Dina Ahmad, Kristi T Lopez, Michelle L Matteson-Kome, Matthew L Bechtold
Alisha M Hinds, Dina Ahmad, Kristi T Lopez, Michelle L Matteson-Kome, Matthew L Bechtold, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
Author contributions: Hinds AM, Ahmad D and Bechtold ML were responsible for the conception and design of the study; Hinds AM, Ahmad D and Lopez KT collected the data and organized data extraction sheets; Matteson-Kome ML and Bechtold ML statistically analyzed the data; Hinds AM, Ahmad D and Lopez KT drafted the manuscript with critical revision being performed by Matteson-Kome ML and Bechtold ML.
Correspondence to: Matthew L Bechtold, MD, FASGE, FACG, Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center, Five Hospital Drive, Columbia, MO 65212, United States. bechtoldm@health.missouri.edu
Telephone: +1-573-8821013 Fax:+1-573-8844595
Received: November 6, 2013
Revised: March 5, 2014
Accepted: April 11, 2014
Published online: May 26, 2014
Processing time: 226 Days and 16.4 Hours
Abstract

AIM: To evaluate the “weekend effect” on outcomes in patient admitted on the weekend for upper gastrointestinal bleeding (UGIB).

METHODS: A comprehensive search was performed (March 2014). Studies comparing weekend and weekday endoscopy in patients with UGIB were included. All studies had at least 2 of 3 primary outcomes which included: mortality, need for surgery, time to endoscopy, endoscopy on admission day, and length of hospital stay. Three authors individually extracted data. Meta-analysis was performed using pooled estimates with odds ratio or mean difference by fixed and random effects models.

RESULTS: Eleven studies met the inclusion criteria. Patients admitted with UGIB on the weekend exhibited a statistically significant increase in mortality (OR = 1.13; 95%CI: 1.06-1.20; P < 0.01), need for surgery (OR = 2.46; 95%CI: 1.51-3.99; P < 0.01), and time to endoscopy (MD 2.68; 95%CI: 0.17-5.20; P = 0.04) as compared to patients admitted with UGIB on a weekday. Furthermore, patients with UGIB admitted on weekend experienced statistically significant less endoscopy on day of admission (OR = 0.72; 95%CI: 0.62-0.85; P < 0.01). No difference was noted between the two groups for length of hospital stay (MD -1.29; 95%CI: -3.03-0.45; P = 0.15).

CONCLUSION: A weekend effect seems to be apparent in patients with UGIB with significantly poorer outcomes.

Keywords: Weekend; Weekday; Upper gastrointestinal bleeding; Endoscopy; Meta-analysis

Core tip: Patients admitted on weekends have been suggested by multiple studies to have poorer outcomes, even in those with gastrointestinal bleeding. Therefore, we conducted a meta-analysis of observational studies to examine the effect of weekend vs weekday admissions for patients with upper gastrointestinal bleeding (UGIB). We discovered that patients with UGIB admitted on weekends had higher mortality, need for surgery, and time to endoscopy compared to those admitted on weekdays. This meta-analysis demonstrates the need for policies to decrease these poorer outcomes for our weekend patients with UGIB.