Published online Oct 14, 2015. doi: 10.3748/wjg.v21.i38.10890
Peer-review started: January 30, 2015
First decision: March 10, 2015
Revised: April 3, 2015
Accepted: June 10, 2015
Article in press: June 10, 2015
Published online: October 14, 2015
Processing time: 269 Days and 10.8 Hours
AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding (UGIB), effects of deprivation and whether weekend presentation affected outcomes.
METHODS: Data was obtained from Information Services Division (ISD) Scotland and National Records of Scotland (NRS) death records for a ten year period between 2000-2001 and 2009-2010. We obtained data from the ISD Scottish Morbidity Records (SMR01) database which holds data on inpatient and day-case hospital discharges from non-obstetric and non-psychiatric hospitals in Scotland. The mortality data was obtained from NRS and linked with the ISD SMR01 database to obtain 30-d case fatality. We used 23 ICD-10 (International Classification of diseases) codes which identify UGIB to interrogate database. We analysed these data for trends in number of hospital admissions with UGIB, 30-d mortality over time and assessed effects of social deprivation. We compared weekend and weekday admissions for differences in 30-d mortality and length of hospital stay. We determined comorbidities for each admission to establish if comorbidities contributed to patient outcome.
RESULTS: A total of 60643 Scottish residents were admitted with UGIH during January, 2000 and October, 2009. There was no significant change in annual number of admissions over time, but there was a statistically significant reduction in 30-d case fatality from 10.3% to 8.8% (P < 0.001) over these 10 years. Number of admissions with UGIB was higher for the patients from most deprived category (P < 0.05), although case fatality was higher for the patients from the least deprived category (P < 0.05). There was no statistically significant change in this trend between 2000/01-2009/10. Patients admitted with UGIB at weekends had higher 30-d case fatality compared with those admitted on weekdays (P < 0.001). Thirty day mortality remained significantly higher for patients admitted with UGIB at weekends after adjusting for comorbidities. Length of hospital stay was also higher overall for patients admitted at the weekend when compared to weekdays, although only reached statistical significance for the last year of study 2009/10 (P < 0.0005).
CONCLUSION: Despite reduction in mortality for UGIB in Scotland during 2000-2010, weekend admissions show a consistently higher mortality and greater lengths of stay compared with weekdays.
Core tip: In this study we have used a large administrative database to demonstrate a significant reduction in mortality from upper gastrointestinal bleeding in Scotland from 2000 to 2010, with stable number of admissions over this time. It is interesting to see this trend during a period of increased incidence of variceal bleeding with a rising burden of chronic liver disease. This is the first report from Scotland demonstrating a “weekend effect” for upper gastrointestinal bleeding. Patients admitted at weekends have significantly higher mortality and a greater length of hospital stay compared with those admitted on weekdays, despite adjustments for comorbidities. These data can help inform resource planning for hospitals at weekends.