The Reduction of After-Hours and Weekend Effects in Upper Gastro-intestinal Bleeding Mortality During the COVID-19 Pandemic Compared to the Pre-Pandemic Period

Sergiu Marian Cazacu; Adina Turcu-Stiolica; Dan Nicolae Florescu; Bogdan Silviu Ungureanu; Vlad Florin Iovanescu; Carmen Daniela Neagoe; Daniela Elena Burtea; Amelia Valentina Genunche-Dumitrescu; Taina Elena Avramescu; Sevastita Iordache

doi:10.2147/JMDH.S427449

The Reduction of After-Hours and Weekend Effects in Upper Gastro-intestinal Bleeding Mortality During the COVID-19 Pandemic Compared to the Pre-Pandemic Period

J Multidiscip Healthc. 2023 Oct 26:16:3151-3165. doi: 10.2147/JMDH.S427449. eCollection 2023.

Affiliations

¹ Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania.
² Biostatistics Department, University of Medicine and Pharmacy Craiova, Dolj County, Romania.
³ Internal Medicine Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania.
⁴ Individual Sports, and Medical Disciplines Departments, University of Craiova, Dolj County, Romania.

^# Contributed equally.

Abstract

Background: In upper gastrointestinal bleeding (UGIB), admissions after normal working hours and during weekends may be associated with increased mortality.

Aim: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: COVID-19 pandemic; after-hours care; gastrointestinal bleeding.

Grants and funding

This work was supported by the ERASMUS + Programme, Key Action 2, Cooperation partnerships in higher education, the project “Development of New Skills for Medical Students in Pandemic Context”, under the Grant Agreement 2022-1-RO01-KA220-HED-000085385.