Cazacu Sergiu Marian, Turcu-Stiolica Adina, Florescu Dan Nicolae, Ungureanu Bogdan Silviu, Iovanescu Vlad Florin, Neagoe Carmen Daniela, Burtea Daniela Elena, Genunche-Dumitrescu Amelia Valentina, Avramescu Taina Elena, Iordache Sevastita
Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania.
Biostatistics Department, University of Medicine and Pharmacy Craiova, Dolj County, Romania.
J Multidiscip Healthc. 2023 Oct 26;16:3151-3165. doi: 10.2147/JMDH.S427449. eCollection 2023.
In upper gastrointestinal bleeding (UGIB), admissions after normal working hours and during weekends may be associated with increased mortality.
To assess the evolution of the after-hours and weekend effects during the COVID-19 pandemic as a result of progressive improved management despite management challenges during the pandemic.
We performed an observational study of patients admitted for UGIB at a tertiary academic center between March 2020 and December 2021, compared to the corresponding timeframe before the pandemic. Admissions were assessed based on regular hours versus after-hours and weekdays versus weekends. We stratified patients based on demographic data, etiology, prognostic scores, the time between symptom onset and admission, as and between admission and endoscopy. The outcomes included mortality, rebleeding rate, the requirement for surgery and transfusion, and hospitalization days.
802 cases were recorded during the pandemic, and 1006 cases before the pandemic. The overall mortality rate was 12.33%. Patients admitted after hours and during weekends had a higher mortality rate compared to those admitted during regular hours and weekdays (15.18% versus 10.22%, and 15.25% versus 11.16%), especially in cases of non-variceal bleeding. However, the difference in mortality rates was reduced by 2/3 during the pandemic, despite the challenges posed by COVID-19 infection. This suggests that there was an equalization effect of care in UGIB, regardless of the admission time. The differences observed in mortality rates for after-hours and weekend admissions seem to be primarily related to a higher proportion of patients who did not undergo endoscopy, while the proportion of severe cases remained similar. Blood requirements, hospital days, and rebleeding rate were similar between the two groups.
Admissions during weekends and after-hours have been associated with increased mortality, particularly in cases of non-variceal bleeding. However, the impact of this association was significantly reduced during the pandemic.
在上消化道出血（UGIB）中，正常工作时间之后及周末入院可能与死亡率增加相关。
评估在2019冠状病毒病（COVID-19）大流行期间，尽管面临管理挑战，但随着管理的逐步改善，非工作时间和周末效应的演变情况。
我们对2020年3月至2021年12月期间在一家三级学术中心因UGIB入院的患者进行了一项观察性研究，并与大流行前的相应时间段进行比较。根据正常工作时间与非工作时间以及工作日与周末对入院情况进行评估。我们根据人口统计学数据、病因、预后评分、症状出现至入院的时间以及入院至内镜检查的时间对患者进行分层。结局指标包括死亡率、再出血率、手术和输血需求以及住院天数。
大流行期间记录了802例病例，大流行前为1006例。总体死亡率为12.33%。与正常工作时间和工作日入院的患者相比，非工作时间和周末入院的患者死亡率更高（分别为15.18%对10.22%，以及15.25%对11.16%），尤其是在非静脉曲张性出血的病例中。然而，尽管COVID-19感染带来了挑战，但在大流行期间死亡率差异减少了2/3。这表明在UGIB中，无论入院时间如何，医疗护理都有均衡效应。非工作时间和周末入院患者死亡率的差异似乎主要与未接受内镜检查的患者比例较高有关，而重症病例的比例保持相似。两组之间的输血需求、住院天数和再出血率相似。
周末和非工作时间入院与死亡率增加相关，特别是在非静脉曲张性出血的病例中。然而，在大流行期间这种关联的影响显著降低。
