title: [Surgical intervention in acute upper gastrointestinal bleeding].
abstract: OBJECTIVE
  Acute gastrointestinal bleeding (AGIB) requiring transfusion and surgical treatment still constitutes a life-threatening situation. The purpose of this paper was to examine the treatment outcome for this group of patients as a function of various risk factors and to present our diagnostic and therapeutic regime.
  
  
  METHODS
  A retrospective analysis of data from 154 patients with AGIB who underwent surgical procedures and received massive transfusions in a university hospital between 1999 and 2008 was carried out.
  
  
  RESULTS
  The patients were divided into two groups. Group I include 91 patients with acute upper gastrointestinal bleeding and group II included 63 patients with lower gastrointestinal bleeding. The average age was 67 years (range 29-93 years) in group I and 70 years (39-97 years) in group II. The initial hemoglobin level was 8.4 g/dl in group I and 10.5 g/dl in group II. Univariate analysis of mortality revealed the following significant risk factors for group I: postoperative need for ventilation (p=0.007), prolonged ICU stay (p=0.004) and anticoagulants in the medical history. The risk factors in group II were blood transfusions >10 units (p=0.031), postoperative need for ventilation (p=0.004), necessary reoperations (p=0.016) and an initial hemoglobin level <8.0 g/dl (p=0.043). The complication rate was 76.9% (mortality rate 34.1%) in group I and 60.3% (mortality rate 15.9%) in group II.
  
  
  CONCLUSIONS
  Examination and stabilization of the patient is directly followed by diagnostic localization. The indication for surgery is mainly limited to peracute, uncontrollable and recurrent forms of gastrointestinal bleeding. The mortality rate for these critically ill, negatively selected patients remains high and could not be lowered in the last decade. Postoperative need of ventilation is a predictor for poor prognosis.
authors.affiliation: Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. ralf_czymek@web.de
authors.forename: R
authors.initials: R
authors.lastname: Czymek
authors.forename: A
authors.initials: A
authors.lastname: Grossmann
authors.forename: U
authors.initials: U
authors.lastname: Roblick
authors.forename: T
authors.initials: T
authors.lastname: Jungbluth
authors.forename: F
authors.initials: F
authors.lastname: Fischer
authors.forename: H-P
authors.initials: HP
authors.lastname: Bruch
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004906:Erythrocyte Count; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
references.citation: Am J Gastroenterol. 1998 Aug;93(8):1202-8
references.pmid: 9707037
references.citation: BMJ. 1997 Aug 30;315(7107):510-4
references.pmid: 9329304
references.citation: J Postgrad Med. 2008 Apr-Jun;54(2):126-34
references.pmid: 18480529
references.citation: Am J Gastroenterol. 2003 Jul;98(7):1494-9
references.pmid: 12873568
references.citation: N Engl J Med. 2000 Jan 13;342(2):78-82
references.pmid: 10631275
references.citation: Scand J Gastroenterol. 1996 Aug;31(8):764-9
references.pmid: 8858744
references.citation: World J Surg. 2008 Jul;32(7):1456-61
references.pmid: 18246388
references.citation: N Engl J Med. 1999 Mar 11;340(10):751-6
references.pmid: 10072409
references.citation: Gastrointest Endosc. 1981 May;27(2):94-102
references.pmid: 6971777
references.citation: Arch Surg. 2008 May;143(5):457-61
references.pmid: 18490553
references.citation: J Gastrointest Surg. 2008 Dec;12(12):2212-20
references.pmid: 18636299
references.citation: Scand J Gastroenterol. 1994 Jun;29(6):569-76
references.pmid: 8079117
references.citation: Gut. 1996 Mar;38(3):316-21
references.pmid: 8675081
references.citation: Am Surg. 2005 May;71(5):392-7
references.pmid: 15986968
references.citation: Am J Gastroenterol. 1997 Mar;92(3):419-24
references.pmid: 9068461
references.citation: Dis Colon Rectum. 2002 Jun;45(6):802-8
references.pmid: 12072634
references.citation: Am J Gastroenterol. 2008 Jul;103(7):1639-47; quiz 1648
references.pmid: 18564127
references.citation: Eur J Gastroenterol Hepatol. 2005 Jun;17(6):641-7
references.pmid: 15879726
references.citation: Br J Surg. 1981 Feb;68(2):109-12
references.pmid: 6970059
references.citation: Am J Gastroenterol. 2001 Jun;96(6):1782-5
references.pmid: 11419829
references.citation: Best Pract Res Clin Gastroenterol. 2008;22(2):233-42
references.pmid: 18346681
references.citation: Best Pract Res Clin Gastroenterol. 2008;22(2):209-24
references.pmid: 18346679
references.citation: Dis Colon Rectum. 2005 Nov;48(11):2010-24
references.pmid: 16175326
references.citation: Am J Gastroenterol. 1995 Feb;90(2):206-10
references.pmid: 7847286
references.citation: Emerg Radiol. 2008 Nov;15(6):413-9
references.pmid: 18512090
references.citation: Am J Surg. 1999 Dec;178(6):587-91
references.pmid: 10670878
references.citation: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002094
references.pmid: 16437441
references.citation: AJR Am J Roentgenol. 1981 Oct;137(4):741-8
references.pmid: 6974970
references.citation: Eur J Gastroenterol Hepatol. 2004 Feb;16(2):177-82
references.pmid: 15075991