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912 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol. 7, No. 8
eply. We appreciate the interest of Nahon and colleagues inur analysis of the “weekend effect” for upper gastrointestinalleeding (UGIB) from the Nationwide Inpatient Sample (NIS).1
n their multi-center cohort from 53 general non-universityospitals in France,2 they found similar mortality for weekend
3.8%) and weekday (6.3%, P � .17) admissions for UGIB-relatedeptic ulcers. Interestingly, they found a shorter mean time tondoscopy for their weekend compared to weekday admissions.here are several possible reasons for the differences in resultsetween the studies. First, it could represent patient tendenciesor earlier or delayed presentation. Second, it could be due tonstitutional, or even national, differences in management al-orithms and supportive care for UGIB; it would be interestingo know if the 53 hospitals had similar or standard UGIB
anagement algorithms. Third, it could be due to the shorterndoscopy time for weekend admissions and the greater rate ofndoscopic intervention noted in their study; in our analysis, weound that the excess mortality was mostly in the group thatid not undergo endoscopic intervention. Interestingly, theverall mortality, need for surgery, and length of stay was muchigher in their study, suggesting a more severely ill cohort.everal additional subgroup analyses would be of interest fromhe study by Nahon et al;2 specifically if there was a “weekendffect” in mortality in any subgroup, such as those with activeleeding, who received endoscopic intervention, or after strati-cation by the Rockall score. In another study from our insti-ution, we identified that hospitals with a high volume ofon-variceal UGIB had lower mortality, suggesting institution-pecific differences in outcomes.1 The “weekend effect,” whileignificant, still offers only a modest contribution to mortalityompared to other patient factors.1,3 Nevertheless, it represents
modifiable risk factor for adverse outcomes in UGIB. Futuretudies from different settings with more detailed informationn patient-level, provider-level, and systems-level variables aressential to identify actionable factors in order to improveatient outcomes.
ASHWIN N. ANANTHAKRISHNAN, MD, MPHDivision of Gastroenterology and HepatologyMedical College of WisconsinMilwaukee, Wisconsin
EMILY L. MCGINLEY, MS, MPHDivision of EpidemiologyMedical College of WisconsinMilwaukee, Wisconsin
KIA SAEIAN, MD, MSC EPI
Division of Gastroenterology and HepatologyMedical College of WisconsinMilwaukee, Wisconsin
. Ananthakrishnan AN, McGinley EL, Saeian K. Outcomes of week-end admissions for upper gastrointestinal hemorrhage: a nation-wide analysis. Clin Gastroenterol Hepatol 2009;7:296–302.e1.
. Nahon S, Nouel O, Hagege H, et al. Favorable prognosis of upper-gastrointestinal bleeding in 1041 older patients: results of a pro-spective multicenter study. Clin Gastroenterol Hepatol 2008;6:886–892.
. Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekdayadmission and mortality from gastrointestinal hemorrhage caused bypeptic ulcer disease. Clin Gastroenterol Hepatol 2009;7:303–310.
onflicts of interestThe authors disclose no conflicts.
doi:10.1016/j.cgh.2009.06.017
Correction
McLaughlin SD, Clark SK, Shafi S, et al. Fecal coliform testing to identify effective antibiotic therapies for patients with antibiotic-resistant pouchitis. Clin Gastroenterol Hepatol 2009;7:545–548.
In the above article, the name of an author was misspelled as Liljana Petrovksa. The correct spelling is Liljana Petrovska.