| Surgical management of acute upper gastrointestinal bleeding:still a major challenge. | |
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MedLine Citation:
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PMID: 22469719 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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Ralf Czymek; Anja Großmann; Uwe Roblick; Andreas Schmidt; Frank Fischer; Hans-Peter Bruch; Philipp Hildebrand |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Hepato-gastroenterology Volume: 59 ISSN: 0172-6390 ISO Abbreviation: Hepatogastroenterology Publication Date: 2012 May-Jun |
Date Detail:
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Created Date: 2012-04-03 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8007849 Medline TA: Hepatogastroenterology Country: Greece |
Other Details:
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Languages: eng Pagination: 768-73 Citation Subset: IM |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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