[Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality].
OBJECTIVE
Multivariate analysis of operative mortality in patients with bleeding peptic ulcer.


METHODS
Seventy-eight consecutive patients, who underwent emergency surgical treatment for bleeding peptic ulcer were reviewed retrospectively. There were 49 males and 29 females, with a mean age of 64.3 years, 2/3 of whom had associated medical disease. Surgical treatment was conservative in 63 cases: oversewing or ulcer excision, alone (n = 29) or associated with vagotomy (n = 34); and was radical in 15 cases: antrectomy+vagotomy (n = 10) or partial gastric resection (n = 5).


RESULTS
There were 17 (21.8%) postoperative deaths and 19 (24.3%) bleeding recurrences. The causes of death included 9 bleeding recurrences, 7 organ failures and one duodenal leakage. On multivariate analysis, previous medical illness (cirrhosis or cardiac insufficiency (P < 0.001), shock at admission (P < 0.001), prolonged delay until surgery (P < 0.001), and bleeding recurrence (P < 0.001) were independently associated with increased mortality. In contrast, the type of surgical procedure did not influence postoperative mortality, whereas bleeding recurrence was more frequent in case of conservative surgery (P < 0.03) and anticoagulation therapy (P < 0.01).


CONCLUSIONS
These results suggest that surgical treatment of bleeding peptic ulcer should be proposed early in high-risk patients. A radical procedure should be favoured since it reduces bleeding recurrence rate without increasing operative mortality.
Dousset
B
B
Service de Chirurgie Digestive, Hôpital Henri-Mondor, Créteil.
Suc
B
B
Boudet
M J
MJ
Cherqui
D
D
Rotman
N
N
Julien
M
M
Fagniez
P L
PL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications / Q000401:mortality* / Q000601:surgery
Traitement chirurgical des hémorragies ulcéreuses graves: facteurs prédictifs de la mortalité opératoire.