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Surgical management of acute upper gastrointestinal bleeding:still a major challenge.
Hepatogastroenterology. 2012 May; 59(115):768-73.H

Abstract

BACKGROUND/AIMS

Acute upper gastrointestinal bleeding (UGIB) that cannot be managed with conservative interventional techniques is a life-threatening condition. This study assesses patient outcome and the role of different risk factors.

METHODOLOGY

We retrospectively analyzed data from 91 patients (58 men, 33 women) admitted between 2000 and 2009 and who underwent surgery for UGIB requiring transfusion.

RESULTS

Mean patient age was 67.4 years. Overall mortality was 34.1%. Causes of bleeding were duodenal ulcer in 57 patients (62.6%) and gastric ulcer in 25 (27.5%). A median number of 21 blood units (range 6-120) were transfused. Surgical treatment consisted of non-resective surgery (52.7%), Billroth II (31.9%), Billroth I (4.4%) or gastric wedge resection (4.4%). The use of anticoagulants (p=0.040), a need for postoperative ventilation (p=0.007) and an intensive care unit (ICU) length of stay >7 days (p=0.004) were identified as significant risk factors for mortality. Transfusions of more than 10 units of blood (p=0.013), the need for further surgery (p=0.021), a prolonged ICU length of stay (p=0.000) and recurrent bleeding (p=0.029) we identified as significant risk factors for postoperative complications (such as pneumonia, sepsis, re-bleeding and anastomotic leakage).

CONCLUSIONS

Over the past decade, mortality has not decreased in patients requiring surgery for acute UGIB despite diagnostic and therapeutic advances, explained by the fact that these cases represent a negative selection of patients after unsuccessful conservative treatment as well as by the rising age of the population and associated increases in comorbidity. Resective surgery, a need for postoperative ventilation and a prolonged ICU length of stay should be added to the list of significant risk factors for mortality.

Authors+Show Affiliations

Department of Surgery, University of Luebeck Medical School, Luebeck, Germany. ralf_czymek@web.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22469719

Citation

Czymek, Ralf, et al. "Surgical Management of Acute Upper Gastrointestinal Bleeding:still a Major Challenge." Hepato-gastroenterology, vol. 59, no. 115, 2012, pp. 768-73.
Czymek R, Groβmann A, Roblick U, et al. Surgical management of acute upper gastrointestinal bleeding:still a major challenge. Hepatogastroenterology. 2012;59(115):768-73.
Czymek, R., Groβmann, A., Roblick, U., Schmidt, A., Fischer, F., Bruch, H. P., & Hildebrand, P. (2012). Surgical management of acute upper gastrointestinal bleeding:still a major challenge. Hepato-gastroenterology, 59(115), 768-73. https://doi.org/10.5754/hge10466
Czymek R, et al. Surgical Management of Acute Upper Gastrointestinal Bleeding:still a Major Challenge. Hepatogastroenterology. 2012;59(115):768-73. PubMed PMID: 22469719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of acute upper gastrointestinal bleeding:still a major challenge. AU - Czymek,Ralf, AU - Groβmann,Anja, AU - Roblick,Uwe, AU - Schmidt,Andreas, AU - Fischer,Frank, AU - Bruch,Hans-Peter, AU - Hildebrand,Philipp, PY - 2012/4/4/entrez PY - 2012/4/4/pubmed PY - 2012/7/3/medline SP - 768 EP - 73 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 59 IS - 115 N2 - BACKGROUND/AIMS: Acute upper gastrointestinal bleeding (UGIB) that cannot be managed with conservative interventional techniques is a life-threatening condition. This study assesses patient outcome and the role of different risk factors. METHODOLOGY: We retrospectively analyzed data from 91 patients (58 men, 33 women) admitted between 2000 and 2009 and who underwent surgery for UGIB requiring transfusion. RESULTS: Mean patient age was 67.4 years. Overall mortality was 34.1%. Causes of bleeding were duodenal ulcer in 57 patients (62.6%) and gastric ulcer in 25 (27.5%). A median number of 21 blood units (range 6-120) were transfused. Surgical treatment consisted of non-resective surgery (52.7%), Billroth II (31.9%), Billroth I (4.4%) or gastric wedge resection (4.4%). The use of anticoagulants (p=0.040), a need for postoperative ventilation (p=0.007) and an intensive care unit (ICU) length of stay >7 days (p=0.004) were identified as significant risk factors for mortality. Transfusions of more than 10 units of blood (p=0.013), the need for further surgery (p=0.021), a prolonged ICU length of stay (p=0.000) and recurrent bleeding (p=0.029) we identified as significant risk factors for postoperative complications (such as pneumonia, sepsis, re-bleeding and anastomotic leakage). CONCLUSIONS: Over the past decade, mortality has not decreased in patients requiring surgery for acute UGIB despite diagnostic and therapeutic advances, explained by the fact that these cases represent a negative selection of patients after unsuccessful conservative treatment as well as by the rising age of the population and associated increases in comorbidity. Resective surgery, a need for postoperative ventilation and a prolonged ICU length of stay should be added to the list of significant risk factors for mortality. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/22469719/Surgical_management_of_acute_upper_gastrointestinal_bleeding:still_a_major_challenge_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -