Trends and predictors for vagotomy when performing oversew of acute bleeding duodenal ulcer in the United States.
BACKGROUND
In the era of Helicobacter pylori treatment, the role of vagotomy in bleeding duodenal ulcers is debatable. National outcomes were evaluated to determine the current surgical treatment and use of vagotomy for bleeding duodenal ulcers.


METHODS
Data from the Nationwide Inpatient Sample (NIS) were used from years 1999 to 2003. Patients were selected using diagnostic codes for acute duodenal ulcer bleed and procedure codes for simple oversew of a bleeding ulcer and vagotomy. Data were analyzed using multiple linear and logistic regression.


RESULTS
Between 1999 and 2003, 100,931 patients with an acute bleeding duodenal ulcer were identified. Over time, there was a decrease in the number of acute bleeding ulcers (p = 0.027) and a decrease in the number of vagotomies (p = 0.027). A high co-morbidity index [odds ratio (OR), 0.60, p = 0.017], operation in the Midwest (OR 0.50, p < 0.001) and operation in the West (OR 0.68, p = 0.034) were predictive of no vagotomy during surgery for a bleeding duodenal ulcer.


CONCLUSIONS
A vagotomy is not commonly performed during surgical treatment of an acute bleeding duodenal ulcer. This variation in practice was not fully explained by patient characteristics. We must seek new evidence to determine the safety of combined medical and surgical management of this clinical problem.
Reuben
Brian C
BC
George E. Whalen Salt Lake City VA Health Care System and, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, Utah 84132, USA.
Stoddard
Greg
G
Glasgow
Robert
R
Neumayer
Leigh A
LA
D000368:Aged; D015897:Comorbidity; D004381:Duodenal Ulcer / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications; D013536:Suture Techniques; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014628:Vagotomy / Q000706:statistics & numerical data* / Q000639:trends