No weekend effect on outcomes of severe acute pancreatitis in Japan: data from the diagnosis procedure combination database
In the early phase of severe acute pancreatitis, timely multidisciplinary management is required to reduce mortality. The aim of this observational study was to evaluate the impact of weekend hospital admission on outcomes using population-based data in Japan.
Data on adult patients (≥20 years) with severe acute pancreatitis were extracted from a nationwide Japanese administrative database covering over 1000 hospitals. In-hospital mortality, length of stay, and total costs were compared between weekend and weekday admissions, with adjustment for disease severity according to the current Japanese severity scoring system for acute pancreatitis, and other potential risk factors.
In total, 8328 patients hospitalized during the study period 2010–2013 were analyzed (2242 admitted at weekends and 6086 on weekdays). In-hospital mortality rates were not significantly different: 5.9 vs. 5.4 % for weekend and weekday admissions, respectively (multivariate-adjusted odds ratio, 1.06; 95 % confidence interval, 0.83–1.35). The impact of weekend admission was not significant either for length of hospitalization (median, 18 vs. 19 days) and total costs (median, 6161 vs. 6233 US dollars) (both p > 0.19 in multivariate-adjusted linear regression). The rates of, and time to, specific treatments were also similar between patients with weekend and weekday admissions.
A weekend effect in severe acute pancreatitis admissions was not evident. Adjustments to weekend staffing and selective hospital referral of patients admitted at weekends are not indicated for severe acute pancreatitis in current clinical practice in Japan.
KeywordsAcute disease Database Mortality Prognosis Severity of illness index
This work was supported by Grants for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (Grant Numbers: H27-Policy-Designated-009 and H27-Policy-Strategy-011).
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to disclose.
- 6.Ananthakrishnan AN, McGinley EL, Saeian K. Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis. Clin Gastroenterol Hepatol. 2009; 7:296–302e1.Google Scholar
- 11.Sekimoto M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13:10–24.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Tenner S, Baillie J, DeWitt J, Vege SS, American College of G. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(1400–15):16.Google Scholar
- 18.Hamada T, Yasunaga H, Nakai Y, Isayama H, Horiguchi H, Fushimi K, et al. Japanese severity score for acute pancreatitis well predicts in-hospital mortality: a nationwide survey of 17,901 cases. J Gastroenterol. 2013.Google Scholar
- 19.Yasunaga H, Hashimoto H, Horiguchi H, Miyata H, Matsuda S. Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database. BMC Health Serv Res. 2012;12:129.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S, Fushimi K. Effect and cost of treatment for acute pancreatitis with or without gabexate mesylate: a propensity score analysis using a nationwide administrative database. Pancreas. 2012.Google Scholar
- 35.Nahon S, Pariente A, Latrive JP, Group of Investigators of the Association Nationale des Gastroenterologues des Hopitaux G. Weekend admission does not influence the mortality of upper gastrointestinal bleeding caused by peptic ulcers: results of a French prospective study of the association nationale des gastroenterologues des hopitaux generaux group. Clin Gastroenterol Hepatol. 2009;7:911 (author reply 2).CrossRefPubMedGoogle Scholar