Effect of holiday admission on clinical outcome of patients with upper gastrointestinal bleeding: A real-world report from Thailand

BACKGROUND: Holiday admissions are associated with poorer clinical outcomes compared with non-holiday admissions. However, data remain inconsistent concerning the “holiday effect” for patients with upper gastrointestinal bleeding. This study compared the differences between clinical courses of patients with upper gastrointestinal bleeding who were admitted on holidays and non-holidays in Thailand. METHODS: We retrospectively reviewed the medical records of patients with upper gastrointestinal bleeding confirmed by endoscopy who were admitted on holidays and non-holidays between January 2016 and December 2017. Mortality, medical resource usage, time to endoscopy, and clinical outcomes were compared between the groups. RESULTS: In total, 132 and 190 patients with upper gastrointestinal bleeding were admitted on holidays and non-holidays, respectively. Baseline characteristics, diagnosis of variceal bleeding, and pre-and post-endoscopic scores were not different between the two groups. Patients admitted on non-holidays were more likely to undergo early endoscopy, within 24 h of hospitalization (78.9% vs. 37.9%, p < 0.001), and had a shorter median time to endoscopy (median [interquartile range]: 17 [12–23] vs. 34 [17–56] h, p < 0.001) than those admitted on holidays. No significant differences in in-hospital mortality rate, number of blood transfusions, endoscopic interventions, additional interventions (including angioembolization and surgery), and length of stay were observed. Patients admitted on holidays had increased admission costs than those admitted on non-holidays (751 [495–1203] vs. 660 [432–1028] US dollars, p= 0.033). After adjusting for confounding factors, holiday admission was a predictor of early endoscopy (adjusted odds ratio 0.159; 95% confidence interval, 0096–0.264, p < 0.001), but was not associated with in-hospital mortality or other clinical outcomes. CONCLUSIONS: Patients with upper gastrointestinal bleeding who were admitted on holidays had a lower rate of early endoscopy, longer time to endoscopy, and higher admission cost than those admitted on non-holidays. Holiday admission was not associated with in-hospital mortality or other clinical outcomes.