周末住院治疗非静脉曲张性上消化道出血——额外的风险?

D. Falcão
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摘要

引言:周末入院与更糟糕的结果有关。本研究的目的是评估“周末效应”对非静脉性上消化道出血(NVUGIB)患者的影响。方法:回顾性分析2016年1月至2018年12月入住波尔图大学中央医院的上消化道出血(UGIB)患者的临床和内镜数据。周末入院与内窥镜检查时间之间的关系;住院水平;手术需求;评估再出血和死亡率。结果:共纳入545例患者。在任何结果中都没有观察到工作日和周末入院之间的显著关联。大多数患者在入院后12小时内接受了上内镜检查(分别为62.0%和57.2%,工作日和周末入院),两组患者的内镜检查时间相似(p=0.607)。在重症监护室和/或中级监护室住院(41.6%和42.8%,p=0.869)与入院日期无关。此外,以下结果也没有差异:手术需求(5.8%vs.6.3%,p=0.843)、再出血(9.3%vs.6.2%,p=0.289)和死亡率(6.2%vs.2.4%,p=0.103)。讨论和结论:在该NVUGIB患者样本中,临床管理和结果与入院日期无关。“周末效应”的缺失似乎与评估的胃肠病应急模型及其持续获得内窥镜资源有关。
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Weekend Hospitalization in Nonvariceal Upper Gastrointestinal Bleeding – an Additional Risk?
Introduction: Weekend admission has been related to worse outcomes. The aim of this study is to assess the impact of the “weekend effect” in patients with nonvariceal uppergastrointestinal bleeding (NVUGIB). Methods: Retrospective analysis of clinical and endoscopic data of patients admitted to Centro Hospitalar Universitário do Porto, from January/2016 to December/2018 for upper gastrointestinal bleeding (UGIB). The association between weekend admission and the timing of endoscopy; level of hospitalisation; surgery need; rebleeding and mortality was evaluated. Results: Atotal of 545 patients were included. No significant association between weekday and weekend admissions was observed in any of the outcomes. The majority of patients underwent upper endoscopy up to 12 hours afteradmission (62.0% vs. 57.2%, weekday vs. weekend admission, respectively), with similar timings of endoscopy between both groups (p=0.607). Hospitalization in intensive and/or intermediate care units (41.6% vs. 42.8%, p=0.869) was not related to the day of admission. Also, no differences were assessed in the following outcomes: surgery need (5.8% vs. 6.3%, p=0.843), rebleeding (9.3% vs. 6.2%, p=0.289) and mortality rates (6.2% vs. 2.4%, p=0.103). Discussion and Conclusion: In this sample of patients with NVUGIB, clinical management and results were independent of the day of admission. The absence of “weekend effect” seems to be related to the gastroenterology emergency model evaluated and its continuous access to endoscopic resources.
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