Weekend vs. Weekday Admissions for Cholangitis Requiring an ERCP: Comparison of Outcomes in a National Cohort

There has been increasing medical literature showing worse outcomes in patients admitted for medical and surgical conditions on the weekend. This has been termed the weekend effect. Little is known whether this weekend effect occurs for patients with cholangitis who require endoscopic retrograde cholangiopancreatography (ERCP), a procedure that requires many resources from the nursing staff, anesthesia, and the endoscopist.

Retrospective analysis from the National Inpatient Sample (NIS) database from 2009 through 2012. Patient data were abstracted from the database for patients admitted on the weekend and weekday with cholangitis who underwent ERCP. Time to ERCP, length of stay, total cost, and mortality were compared in patients admitted with cholangitis on the weekend vs. weekday who required ERCP. ERCP adverse events were recorded from the weekend vs. weekday as well.

Twenty-three thousand six-hundred sixty-one patients were identified in the NIS database who were admitted for cholangitis who required ERCP in the study period, of which 18,106 (76.5%) patients were admitted on the weekday, whereas 5,555 (23.5%) were admitted on the weekend. By 24 h, the weekday group had undergone ERCP more frequently than the weekend group (54.6 vs. 43%; P<0.001). By 48 h, the weekday group had undergone ERCP more frequently than the weekend group (70 vs. 65.4%; P<0.001). By 72 h, both groups had undergone a similar rate of ERCP (79.7 vs. 78.9%; P=0.17). There was no statistical difference between the groups for in-hospital all-cause mortality (2.86 vs. 2.56%; P=0.24), length of stay (6.97 days vs. 6.88 days; P=0.28), or total cost of hospitalization ($71,552 vs $71,469; P=0.94).

Despite a delay in regard to time to ERCP for weekend admissions, there was no weekend effect observed in regard to length of stay, mortality, or total cost of hospitalization. Although biliary drainage with ERCP is important, these results suggest that other factors in the management of cholangitis (e.g., antibiotics and intravenous fluids) contribute to outcomes.