P373 Impact of weekend admissions on outcomes in patients admitted with acute cholangitis

Introduction Negative outcomes have been demonstrated in patients with certain medical or surgical conditions who are admitted on weekends. The weekend effect is not clear in patients with acute cholangitis due to paucity of literature regarding this phenomenon. We aim to analyse the impact of weekend admissions for patients with acute cholangitis to our tertiary hepatobiliary centre on clinical outcomes. Methods A retrospective analysis of patients admitted to our hospital with acute cholangitis over a 3 year period from June 2016 to June 2019 was carried out. Patients were identified via our hospital’s coding department by ICD-10 codes K83, K80.3 and K80.5. Individual case notes were analysed to exclude patients who did not meet Tokyo consensus criteria for diagnosis of acute cholangitis. Patients admitted from Monday 09:00 to Friday 17:00 were classified as weekday admissions (WD) and patients admitted from Friday 17:01 to Monday 08:59 were classified as weekend admissions (WE). Statistical analyses between the groups were carried out with t-test or chi-square tests where appropriate. Results The cohort consisted of 275 patients (53.3% female) with a median age of 72 years (range 19 – 97). 68.1% of patients (n=188) were WD admissions. 13.7% of WE admissions and 16.5% of WD admissions were classified as severe cholangitis (p=0.58). Malignancy as the cause of cholangitis was observed in 14.9% of WE group and 12.2% of WD group (p=0.54). Intensive care admissions were observed in 5.7% of the WE group and 3.2% in the WD group (p=0.32). 88.3% (n=166) of patients in the WD group and 86.4% (n=76) of patients in the WE group underwent endoscopic retrograde cholangiopancreatography (ERCP) during their admission; with the remaining patients deemed unsuitable to undergo ERCP. 4 patients underwent emergency out of hours ERCP (2 patients from each group). There was no difference between median time from admission to ERCP (WD 5.4 days, WE 4.9 days; p = 0.78) or length of stay (WD 8.1 days vs WE 8.2 days, p=0.98). The 30-day all-cause mortality rate was 3.7% in the WD group and 6.9% in the WE group (p=0.25) and in those who underwent ERCP: 2.4% in the WD group and 3.9% in the WE group (p=0.51). 83.3% of WE deaths and 71.4% of WD deaths were of patients who had cholangitis of malignant aetiology. Conclusions Our data did not demonstrate a clear ‘weekend effect’ in patients admitted to a tertiary hepatobiliary centre with acute cholangitis, although there was a trend towards increased intensive care admissions and 30-day mortality amongst patients admitted over the weekend. Further studies on a regional or national level may be warranted.