Adherence To Healthcare Maintenance Among Women With Inflammatory Bowel Disease: Results From The Piano Registry

Background:The weekend effect describes worsened outcomes that are due to a perceived inefficiency that occurs over the weekend.Prior studies have proved this phenomenon in the management of pulmonary embolism, stroke, and gastrointestinal bleed.Therefore, there is justifiable concern over prolonged hospital course and sub-optimal care on the weekend.This effect has not yet been studied in inflammatory bowel disease (IBD), despite its increasing prevalence in the community.Therefore, it is our aim to assess the differences in outcome of weekend versus weekday management of IBD exacerbations.Methods: The National Inpatient Sample (NIS) is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States.We collected data from the years 2008 to 2014.Cases of IBD flare (Crohn's Disease and Ulcerative Colitis (UC)) were identified using the International Classification of Diseases, Ninth Edition, Clinical Modification codes and associated diagnoses of complications.Differences in time to first endoscopy or colonoscopy, length of stay (LOS), and cost were evaluated for patients with Crohn's Disease or UC flare between weekend and weekday admissions and adjusted for demographics, insurance payer, hospital characteristics, and comorbidities.Results: Between 2008 and 2014, there were 193,848 cases of IBD flares identified.There were 152,089 cases admitted on weekdays vs 41,759 cases on a weekend.The time to first endoscopy or colonoscopy was 3.33 days on weekends vs. 3.19 days on weekdays with a p<0.001.The mean LOS was shorter when admissions occurred on weekends vs. weekdays (8.01 days vs. 8.22 days, p<0.001).Finally, the cost of hospitalization was higher in weekday admissions vs. weekend admissions ($18,072 vs. $17,495, p<0.001).Using linear logistic regression and binary logistic regression models and adjusting for baseline patient demographics, comorbid conditions, and hospital characteristics, the time to first procedure, LOS, and cost remained statistically significant.Conclusion: Our results showed a similar LOS and cost associated with management of IBD exacerbations on the weekend compared to weekdays.Whereas many high risk conditions exhibit increased mortality and prolonged hospital course over the weekend, this phenomenon does not appear to affect IBD.As these findings do indicate efficient patient care, it should dispel some apprehension regarding weekend treatment of IBD flares.