ABSTRACT
Objectives: To evaluate the impact of weekend admission on the outcome of patients with acute variceal hemorrhage [AVH] Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA Main Outcome Measures: AVH, weekend admission and clinical outcome
Subjects: Nine hundred and thirty-seven admitted during the period 1[st] January 2005 to 31[st] July 2013 and documented to have AVH. The selected patients were divided into two groups based on the admission day [weekday or weekend admission]. The data regarding patients characteristics and outcome in both the groups were retrieved from medical records and compared by using c2 test / Fisher's exact and student T- test
Results: Weekday admissions included 685 patients, while the weekend group comprised of 252 patients. The demographic, clinical and laboratory characteristics of patients admitted with AVH in both the groups were comparable. Statistically, there was no significant difference in the need for blood transfusion [46% versus 48%, p = 0.5868], and surgical intervention [5.4% versus 4.7%; p = 0.6595] between the groups. There was a little, but statistically significant delay in endoscopic intervention in the weekend group [7.56 +/- 7.8 hours versus 9 +/- 2.32; p = < 0.0001]. However, this delay did not lead to adverse outcome for patients [mortality rate 6.8% versus 5.25%; p = 0.389]
Conclusions: The weekend admissions were not associated with increased mortality in patients with AVH. Moreover, the length of hospital stay, need for blood transfusion, and rate of surgical intervention were similar in weekdays and weekend admissions
ABSTRACT
To determine the use of liver function tests [LFTs] as a selection tool for preoperative endoscopic retrograde cholangiopancreatography [ERCP] in patients with mild gallstone pancreatitis. All patients admitted with mild gallstone pancreatitis with deranged LFTs in King Saud Medical City, Riyadh, Kingdom of Saudi Arabia between January 2006 and February 2013 were studied retrospectively. Patients' demography, symptoms, laboratory values, imaging studies, ERCP findings, complications and its treatment, surgical intervention, intraoperative and postoperative findings, mortality, and outpatient follow up were collected and analyzed. A total of 245 patients were admitted as mild gallstone pancreatitis with admission day deranged LFTs. Pre-operative ERCP was performed in 74 patients based on admission day LFTs [Group A]. Endoscopic retrograde cholangiopancreatography was normal in 65 patients, revealed stones in 5, and sludge in 4 patients. Six patients developed ERCP complications. Endoscopic retrograde cholangiopancreatography was deferred in 171 patients [Group B] until the LFTs were repeated in 3-4 days. Liver function tests remained persistently high in 8 patients. They were submitted to preoperative ERCP, which revealed stones [n=5] and sludge [n=3]. Patients with normalized LFTs [n=163] were not submitted to ERCP. Three of them developed gallstone related complications. Patients admitted with predicted mild gallstone pancreatitis, deranged LFTs, and no evidence of cholangitis should not be submitted to ERCP unless a repeat LFT within 3-4 days shows persistently deranged LFTs. This will reduce unnecessary ERCP and its complications