A 13-year nationwide analysis of “the weekend effect” on outcomes of esophageal variceal bleed

Background: Esophageal variceal bleeding (EVB) is a common gastrointestinal (GI) emergency associated with a high risk of morbidity and mortality. Esophageal varices are a result of portal hypertension, commonly caused by cirrhosis. When these varices rupture, they cause rapid exsanguination if not intervened on quickly. Hospital admissions during the weekend are associated with worse outcomes in many categories of emergent GI pathology, including upper GI hemorrhage. However, the relationship between weekend admission and hospital outcomes for EVB patients remains controversial. Our study aims to investigate this potential disparity further using a large nationwide sample. Methods: The National Inpatient Sample (NIS) [2008-2020] was used, patients over 18 with a primary EVB diagnosis using ICD-9/10 codes were selected. Patients were grouped by weekend or weekday admission. Baseline characteristics (age, gender, race, insurance, comorbidities) were compared. Outcomes included mortality, shock, acute myocardial infarction (AMI), acute kidney injury (AKI), composite outcome, length of stay (LOS), hospital charges, endoscopy/TIPS performance, and procedure timeliness. Weighted logistic regression calculated odds ratios (ORs), adjusted for age, gender, race, hospital characteristics, region, and Charlson Comorbidity Index (CCI). Results: Of 322,155 EVB patients, 82,293 were weekend admissions, and 239,862 were weekday admissions. Baseline characteristics [age (P=0.07), gender (P=0.71), race (P>0.05), insurance (P>0.05)) were similar. Patients admitted on weekends had lower rates of anemia but higher smoking (P=0.005), alcohol use disorder (P=0.002), more medically complex (CCI 5.30 vs. 5.25, P=0.03). The two groups had similar rates of mortality (P=0.14), AMI (P=0.18), and AKI (P=0.14). Weekends had higher odds of shock (OR 1.14, CI 1.08-1.21, P