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Surgical management of acute upper gastrointestinal bleeding:still a major challenge.
- Source :
-
Hepato-gastroenterology [Hepatogastroenterology] 2012 May; Vol. 59 (115), pp. 768-73. - Publication Year :
- 2012
-
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.<br />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.<br />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).<br />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.
- Subjects :
- Acute Disease
Adult
Aged
Aged, 80 and over
Anticoagulants therapeutic use
Chi-Square Distribution
Duodenal Ulcer complications
Duodenal Ulcer diagnosis
Female
Gastrointestinal Hemorrhage diagnosis
Gastrointestinal Hemorrhage etiology
Gastrointestinal Hemorrhage mortality
Germany
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Peptic Ulcer Hemorrhage diagnosis
Peptic Ulcer Hemorrhage etiology
Peptic Ulcer Hemorrhage mortality
Recurrence
Respiration, Artificial
Retrospective Studies
Risk Assessment
Risk Factors
Stomach Ulcer complications
Stomach Ulcer diagnosis
Time Factors
Treatment Outcome
Gastrointestinal Hemorrhage surgery
Hemostatic Techniques adverse effects
Hemostatic Techniques mortality
Peptic Ulcer Hemorrhage surgery
Subjects
Details
- Language :
- English
- ISSN :
- 0172-6390
- Volume :
- 59
- Issue :
- 115
- Database :
- MEDLINE
- Journal :
- Hepato-gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 22469719
- Full Text :
- https://doi.org/10.5754/hge10466